Provider Demographics
NPI:1205879905
Name:GOLDSMITH, WILLIAM BERNARD (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BERNARD
Last Name:GOLDSMITH
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 1:13-36 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1813
Mailing Address - Country:US
Mailing Address - Phone:201-797-2020
Mailing Address - Fax:201-797-0416
Practice Address - Street 1:13-36 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1813
Practice Address - Country:US
Practice Address - Phone:201-797-2020
Practice Address - Fax:201-797-0416
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00355900152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3116107Medicaid
NJ521300Medicare PIN
T77808Medicare UPIN
NJ3116107Medicaid