Individual
PHILLLIP GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
204 MAIN STREET SHOP CTR, WATERLOO, NY 13165-1454
(315) 539-1209
Mailing address
204 MAIN STREET SHOP CENTRE, WATERLOO, NY 13165
(315) 329-1904
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
010346
NY
Other
Enumeration date
01/22/2021
Last updated
01/22/2021
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