Provider Demographics
NPI:1134172307
Name:GOLDSTEIN, MARSHALL L (OD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:L
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 1:201 E BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4902
Mailing Address - Country:US
Mailing Address - Phone:814-238-2862
Mailing Address - Fax:814-234-2201
Practice Address - Street 1:201 E BEAVER AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4902
Practice Address - Country:US
Practice Address - Phone:814-238-2862
Practice Address - Fax:814-234-2201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE4231P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0229290001Medicaid
PA0229290001Medicaid
PAT28217Medicare UPIN