Provider Demographics
NPI:1851617567
Name:MICHAEL A GOLDSMID, O.D., AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:MICHAEL A GOLDSMID, O.D., AN OPTOMETRIC CORPORATION
Other - Org Name:ARENA EYEWORKS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOLDSMID
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-224-2879
Mailing Address - Street 1:3750 SPORTS ARENA BLVD
Mailing Address - Street 2:#9
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5129
Mailing Address - Country:US
Mailing Address - Phone:619-224-2879
Mailing Address - Fax:
Practice Address - Street 1:3750 SPORTS ARENA BLVD
Practice Address - Street 2:#9
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5129
Practice Address - Country:US
Practice Address - Phone:619-224-2879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACY684AMedicare PIN