Individual
DR. RAYMOND C. GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
317 MAIN ST, GOODING, ID 83330-1302
(208) 934-4856
(208) 934-5818
Mailing address
317 MAIN ST, GOODING, ID 83330-1302
(208) 934-4856
(208) 934-5818
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100008
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010138989
REGENCE BLUE SHIELD
ID
05
—
806370300
—
ID
01
—
V050-0
BLUE CROSS
ID
Enumeration date
05/31/2005
Last updated
03/09/2011
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