Provider Demographics
NPI:1003093188
Name:GOLDMAN, RUTH L (OD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:L
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24100 EL TORO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637
Mailing Address - Country:US
Mailing Address - Phone:949-586-8980
Mailing Address - Fax:949-586-0624
Practice Address - Street 1:24100 EL TORO RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637
Practice Address - Country:US
Practice Address - Phone:949-586-8980
Practice Address - Fax:949-586-0624
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8961TPL152W00000X
CA8961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist