Provider Demographics
NPI:1164043386
Name:GOODYEAR, KENDALL LYN (MD)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:LYN
Last Name:GOODYEAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3705 MEDICAL PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1022
Mailing Address - Country:US
Mailing Address - Phone:512-458-2141
Mailing Address - Fax:512-458-2141
Practice Address - Street 1:3705 MEDICAL PKWY STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1022
Practice Address - Country:US
Practice Address - Phone:512-458-2141
Practice Address - Fax:512-458-4824
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2024-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU8332207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program