Individual
LEE R GOODFELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6680 DIVISION AVE S, GRAND RAPIDS, MI 49548-7834
(616) 455-2525
(616) 455-9135
Mailing address
6680 DIVISION AVE S, GRAND RAPIDS, MI 49548-7834
(616) 455-2525
(616) 455-9135
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003189
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2589040
—
MI
01
—
410021740
RAILROAD MEDICARE
—
01
—
OD16514
BCBS
—
Enumeration date
10/11/2006
Last updated
06/05/2023
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