Provider Demographics
NPI:1710972955
Name:GOLDSMITH, WENDY A (OD)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:A
Last Name:GOLDSMITH
Suffix:
Gender:F
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: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 1:1101 1ST ST NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2197
Practice Address - Country:US
Practice Address - Phone:952-758-2080
Practice Address - Fax:952-758-5922
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2402152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN012025100Medicaid
MN410001706Medicare PIN
U33516Medicare UPIN