Provider Demographics
NPI:1336709138
Name:GOLDBERG, AMANDA NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:NICOLE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 N SCOTTSDALE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5230
Mailing Address - Country:US
Mailing Address - Phone:480-513-3937
Mailing Address - Fax:
Practice Address - Street 1:10900 N SCOTTSDALE RD STE 301
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5230
Practice Address - Country:US
Practice Address - Phone:480-513-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist