Provider Demographics
NPI:1275509598
Name:GOLDSTON, RICHARD RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RONALD
Last Name:GOLDSTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 NORTHPOINT BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-870-3939
Mailing Address - Fax:423-877-0024
Practice Address - Street 1:1920 NORTHPOINT BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-870-3939
Practice Address - Fax:423-877-0024
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2240056OtherUNITED HEALTHCARE
TN3593903Medicaid
TN2009346OtherBLUE CROSS BLUE SHIELD
TN2009346OtherBLUE CROSS BLUE SHIELD
2240056OtherUNITED HEALTHCARE