Provider Demographics
NPI:1235491861
Name:GOLDBERG, NATHAN E (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:E
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1880 W WINCHESTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5321
Mailing Address - Country:US
Mailing Address - Phone:847-362-3811
Mailing Address - Fax:847-362-0428
Practice Address - Street 1:1880 W WINCHESTER RD STE 105
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5321
Practice Address - Country:US
Practice Address - Phone:847-362-3811
Practice Address - Fax:847-362-0428
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist