Provider Demographics
NPI:1578749032
Name:GOLDSTEIN, LEONARD J (OD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:EMPIRE VISION CENTER, INC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-446-3145
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:3039 ROUTE 50
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2937
Practice Address - Country:US
Practice Address - Phone:518-580-1117
Practice Address - Fax:518-580-1311
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002947152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT48927Medicare UPIN