Provider Demographics
NPI:1154569796
Name:GOODE, TORY JUSTINE (OD)
Entity type:Individual
Prefix:DR
First Name:TORY
Middle Name:JUSTINE
Last Name:GOODE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-0511
Mailing Address - Country:US
Mailing Address - Phone:713-320-1300
Mailing Address - Fax:435-657-1556
Practice Address - Street 1:425 E 1200 S
Practice Address - Street 2:STE. 200
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3943
Practice Address - Country:US
Practice Address - Phone:435-657-1555
Practice Address - Fax:435-657-1556
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3297ATI152W00000X
TX7211T152W00000X
UT7671967-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist