Organization
GOODWILL OPTICAL INC
Active
Other names
GOODWILL OPTICAL
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY D WESTRA (PRESIDENT)
(616) 846-0620
Entity
Organization
Contact information
Practice address
4340 MILLER RD, SUITE A, FLINT, MI 48507-1297
(810) 230-0045
(810) 230-0045
Mailing address
105 W EXCHANGE ST, SPRING LAKE, MI 49456-2024
(616) 846-0620
(616) 844-6079
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003723
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447319710
—
MI
Enumeration date
05/10/2011
Last updated
05/10/2011
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