Provider Demographics
NPI:1407086739
Name:GOLDSTEIN, KATIE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 PLEASANT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-4765
Mailing Address - Country:US
Mailing Address - Phone:503-302-4004
Mailing Address - Fax:
Practice Address - Street 1:788 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2725
Practice Address - Country:US
Practice Address - Phone:541-727-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7411T152W00000X
CA13923152W00000X
OR3589AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist