Provider Demographics
NPI:1770652380
Name:GOLDSCHMIDT, DORRINE H (OD)
Entity Type:Individual
Prefix:DR
First Name:DORRINE
Middle Name:H
Last Name:GOLDSCHMIDT
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 1919
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-1919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:754 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2696
Practice Address - Country:US
Practice Address - Phone:205-631-7700
Practice Address - Fax:205-631-0990
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS754TA234152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529804360Medicaid
AL529804360Medicaid
AL000058555Medicare PIN
AL1306000001Medicare NSC