Provider Demographics
NPI:1619913860
Name:GOLDSTEIN, RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2153
Mailing Address - Country:US
Mailing Address - Phone:212-249-0002
Mailing Address - Fax:212-249-5248
Practice Address - Street 1:243 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2153
Practice Address - Country:US
Practice Address - Phone:212-249-0002
Practice Address - Fax:212-249-5248
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYV4856152WC0802X, 152WP0200X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT49099Medicare UPIN