Provider Demographics
NPI:1548309867
Name:GOODMAN, DAVID TODD (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:TODD
Last Name:GOODMAN
Suffix:
Gender:M
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 419
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-0419
Mailing Address - Country:US
Mailing Address - Phone:731-968-2020
Mailing Address - Fax:731-968-2866
Practice Address - Street 1:107 LEXINGTON PLZ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1505
Practice Address - Country:US
Practice Address - Phone:731-968-2020
Practice Address - Fax:731-968-2866
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2240164OtherUNITED HEALTHCARE
TN3941001Medicaid
TN13286OtherTLC MANAGED CARE SERVICES
TN3044127OtherBLUE CROSS BLUE SHIELD
TN3941001Medicaid
TN2240164OtherUNITED HEALTHCARE
TN3941001Medicare ID - Type Unspecified
0659250001Medicare NSC
TNU62885Medicare UPIN