Organization
GOODRICH OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID S GOODRICH ABOM (CIO)
(517) 393-2660
Entity
Organization
Contact information
Practice address
6425 S PENNSYLVANIA AVE STE 13, LANSING, MI 48911-5975
(517) 393-2660
(517) 393-1313
Mailing address
2450 DELHI COMMERCE DR STE 1, HOLT, MI 48842-2193
(517) 393-2660
(517) 393-1313
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-00278
PHYSICIANS HEALTH PLAN
MI
01
—
22-70051
PHP FAMILY CARE
MI
01
—
900C313260
BLUE CROSS OF MICHIGAN
MI
01
—
OP0850
EYEMED
MI
Enumeration date
09/20/2006
Last updated
10/01/2019
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