Provider Demographics
NPI:1437612850
Name:GOLDSTONE, BRIAN (ABOC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GOLDSTONE
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 NEWHOPE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4251
Mailing Address - Country:US
Mailing Address - Phone:714-545-1024
Mailing Address - Fax:
Practice Address - Street 1:17150 NEWHOPE ST STE 305
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4251
Practice Address - Country:US
Practice Address - Phone:714-545-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186289156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician