Glen K Goodman
Ophthalmologist
87 Grandview Ave
Waterbury
, Connecticut 06708-2514
Glen K Goodman
Ophthalmologist
87 Grandview Ave
Waterbury
, Connecticut 06708-2514
(203) 574-2020
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About
Features
Specialties
- Ophthalmologist
Languages spoken
- English
Location
First Address
- Glen K Goodman
- 87 Grandview Ave
- Waterbury, CT
- Zip : 06708-2514
- Phone : (203) 574-2020
Second Address
- Glen K Goodman
- 87 Grandview Ave
- Waterbury, CT
- Zip : 06708-2514
- Phone : (203) 574-2020
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207W00000X | Ophthalmologist | 46944 | MA |
| Y | 207W00000X | Ophthalmologist | 67111 | CT |
National Provider Identifier
| NPI | 1043218159 |
|---|---|
| Provider Name | Glen K Goodman |
| First Address | Waterbury, CT 06708-2514 |
| Second Address | Waterbury, CT 06708-2514 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/07/2005 |
| Last Update Date | 03/11/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0177555 | (05) | MA |
| B73598 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.