Provider Demographics
NPI:1467643353
Name:NORMAN M GOLDGLANTZ O D P A
Entity Type:Organization
Organization Name:NORMAN M GOLDGLANTZ O D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDGLANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:954-717-0036
Mailing Address - Street 1:14030 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3443
Mailing Address - Country:US
Mailing Address - Phone:305-981-4775
Mailing Address - Fax:305-981-4766
Practice Address - Street 1:5542 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1412
Practice Address - Country:US
Practice Address - Phone:954-717-0036
Practice Address - Fax:954-717-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD026AMedicare PIN