Individual
TERRY L GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
9501 TAYLORSVILLE RD STE 106, LOUISVILLE, KY 40299-2752
(502) 499-2020
(502) 499-6747
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1071DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77010718
—
KY
01
—
P00106428
RR MEDICARE
KY
Enumeration date
01/30/2007
Last updated
08/10/2023
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