Individual
MR. DANIEL GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
204 MAIN STREET SHOP CTR, WATERLOO, NY 13165-1454
(315) 539-1209
(607) 739-8454
Mailing address
204 MAIN STREET SHOP CTR, WATERLOO, NY 13165-1454
(315) 539-1209
(607) 739-8454
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
C004107-1
NY
Other
Enumeration date
03/27/2007
Last updated
11/03/2008
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