Provider Demographics
NPI:1770526287
Name:GOLDGLANTZ, NORMAN M (OD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:M
Last Name:GOLDGLANTZ
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 1:14030 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3443
Mailing Address - Country:US
Mailing Address - Phone:305-981-4775
Mailing Address - Fax:305-981-4766
Practice Address - Street 1:14030 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3443
Practice Address - Country:US
Practice Address - Phone:305-981-4775
Practice Address - Fax:305-981-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1276152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19066OtherBLUE SHIELD BLUE CROSS FL
FL19066OtherBLUE SHIELD BLUE CROSS FL
FL19066Medicare ID - Type Unspecified