Individual
STEPHEN GOODWIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
1230 AMELIA ST, ORANGEBURG, SC 29115-5478
(803) 531-0061
(803) 531-0095
Mailing address
1230 AMELIA ST, ORANGEBURG, SC 29115-5478
(803) 531-0061
(803) 531-0095
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
584
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DV5842
—
SC
Enumeration date
12/16/2005
Last updated
07/08/2007
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