Provider Demographics
NPI:1215768395
Name:GOODE, KORRIN ALDINE (OD)
Entity type:Individual
Prefix:
First Name:KORRIN
Middle Name:ALDINE
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 1:5428 NEW MILLS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2247
Mailing Address - Country:US
Mailing Address - Phone:619-861-2488
Mailing Address - Fax:
Practice Address - Street 1:11972 BERNARDO PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2538
Practice Address - Country:US
Practice Address - Phone:858-451-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35806-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist