Provider Demographics
NPI:1508846965
Name:GOLDSTEIN, LEONARD S (OD,PC)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:S
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:OD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5156
Mailing Address - Country:US
Mailing Address - Phone:718-271-6883
Mailing Address - Fax:718-699-5905
Practice Address - Street 1:5910 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5156
Practice Address - Country:US
Practice Address - Phone:718-271-6883
Practice Address - Fax:718-699-5905
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003454152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23162OtherGHI
NY49829OtherDAVIS VISION
NYP-11165056OtherMULTIPLAN
NY00684735Medicaid
NYQN0039301OtherAMERICHOICE
NY1C9059OtherHEALTHNET
NY316240101OtherHEALTHPLUS
NY905855/004545OtherBLOCK VISION
NY90623OtherAETNA
NYG5910 999995631OtherVISION SERVICE PLAN
NY718-96OtherUNITED HEALTHCARE
NYC3241OtherBLUE CROSS BLUE SHIELD
NYP2085463OtherOXFORD HEALTHCARE
NY90623OtherAETNA
NY49829OtherDAVIS VISION
NYG5910 999995631OtherVISION SERVICE PLAN