Provider Demographics
NPI:1790733467
Name:GOLDSTEIN, ALAN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOSEPH
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 1:4505 LAS VIRGENES RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-222-4393
Mailing Address - Fax:818-222-9522
Practice Address - Street 1:4505 LAS VIRGENES RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1956
Practice Address - Country:US
Practice Address - Phone:818-222-4393
Practice Address - Fax:818-222-9522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6672T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6672TOtherOPTOMETRY
T70128Medicare UPIN