Provider Demographics
NPI:1952300238
Name:GOLDSTEIN, LEE ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ARTHUR
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 1:45493 S FORK DR
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:CA
Mailing Address - Zip Code:93271-9318
Mailing Address - Country:US
Mailing Address - Phone:559-561-3204
Mailing Address - Fax:
Practice Address - Street 1:45493 S FORK DR
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:CA
Practice Address - Zip Code:93271-9318
Practice Address - Country:US
Practice Address - Phone:559-561-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-12-15
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CA4783T152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4783TOtherSTATE BOARD - OPT LICENSE
CA7645215Medicaid
CA0640320001Medicare ID - Type Unspecified
CA7645215Medicaid