Provider Demographics
NPI:1275786691
Name:GOLDSTEIN, IRA E (OD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:E
Last Name:GOLDSTEIN
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 1:5900 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5404
Mailing Address - Country:US
Mailing Address - Phone:561-967-4548
Mailing Address - Fax:561-967-4572
Practice Address - Street 1:5900 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-5404
Practice Address - Country:US
Practice Address - Phone:561-967-4548
Practice Address - Fax:561-967-4572
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1277152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0848107 00Medicaid
FL0848107 00Medicaid