Provider Demographics
NPI:1942212428
Name:GOLDBERG, DAVID MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MITCHELL
Last Name:GOLDBERG
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 1:6301 LITTLE RIVER TPKE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5044
Mailing Address - Country:US
Mailing Address - Phone:703-750-1585
Mailing Address - Fax:703-750-1587
Practice Address - Street 1:6301 LITTLE RIVER TPKE STE 110
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5044
Practice Address - Country:US
Practice Address - Phone:703-750-1585
Practice Address - Fax:703-750-1587
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2028250OtherAETNA
VA541122182OtherCIGNA
VA010023238Medicaid
242447OtherMAMSI/UNITED HEALTH
VA43671OtherDAVIS VISION
VAVA0863OtherEYEMED
VAT30893Medicare UPIN
VA43671OtherDAVIS VISION
VA016330Medicare ID - Type Unspecified