Provider Demographics
NPI:1821113382
Name:GOLDSTEIN, JEFFREY STUART (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STUART
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9 CAMPITELLI CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6039
Mailing Address - Country:US
Mailing Address - Phone:410-833-3688
Mailing Address - Fax:
Practice Address - Street 1:10480 LITTLE PATUXENT PKWY
Practice Address - Street 2:G-100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3568
Practice Address - Country:US
Practice Address - Phone:410-740-7430
Practice Address - Fax:410-740-7433
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDA0723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD89034Medicare UPIN