Terry L Goodman, OD
Individual provider Active NPI Optometrist · Louisville, KY
NPI 1831235498 · NPPES record last updated Aug 10, 2023
Key facts
- NPI
- 1831235498
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1071DT (KY)
- Practice address
- 9501 Taylorsville Rd Ste 106
Louisville, KY 40299-2752 - Phone
- (502) 499-2020
- Fax
- (502) 499-6747
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090519000008 | KY | Practitioner - Optometry | 5698824852 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1071DT | KY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ward Family Eye Care PLLC | Optometrist | Current |
Accepting new patients |
| Senior Health Services LLC | Optometrist | Current |
Accepting new patients |
| John Kenyon American Eye Institute LLC | Past | Accepting new patients |
Locations
2555 Highway 227
Carrollton, KY 41008
Phone (502) 662-0107
100 Walmart Dr
Elizabethtown, KY 42701
Phone (270) 737-0055
2932 Breckenridge Ln
Ste 5
Louisville, KY 40220
Phone (502) 371-9703
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1071DT | KY | Yes |
Addresses
Primary practice location
9501 Taylorsville Rd Ste 106
Louisville, KY 40299-2752
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00106428 | Other | KY | RR MEDICARE |
| 77010718 | Medicaid | KY |
Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.