Provider Demographics
NPI:1659470144
Name:GOLDSTEIN, RONALD L (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:277 HAMPSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2408
Mailing Address - Country:US
Mailing Address - Phone:805-495-4625
Mailing Address - Fax:805-496-2020
Practice Address - Street 1:277 HAMPSHIRE RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-2408
Practice Address - Country:US
Practice Address - Phone:805-495-4625
Practice Address - Fax:805-496-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4251T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP4251AMedicare PIN