| Doctor Name: | MR. KIP MCGOODEN |
| NPI Number: | 1114089943 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.D.O. |
| License Number: | 2717 |
| Business Practice Address: | 783 Rio Del Mar Blvd Ste 37 Aptos, CA - 950034700 |
| Business Phone Number: | 8316881516 |
| Business Fax Number: | |
| Mailing Address: | 783 Rio Del Mar Blvd, Ste 37 APTOS |
| State: | CA |
| Postal Code: | 950034771 |
| Phone Number: | 8316881516 |
| Fax Number: | |
| NPI Enumeration Date: | 12/15/2006 |
| NPI Last Update Date: | 08/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 2717 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |