Provider Demographics
NPI:1609128545
Name:GOLDSMITH EYE CARE PC
Entity Type:Organization
Organization Name:GOLDSMITH EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-758-2080
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-0261
Mailing Address - Country:US
Mailing Address - Phone:952-758-2080
Mailing Address - Fax:952-758-5922
Practice Address - Street 1:112 MAIN ST E
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2440
Practice Address - Country:US
Practice Address - Phone:952-758-2080
Practice Address - Fax:952-758-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6758990001Medicare NSC