Provider Demographics
NPI:1811059280
Name:GOLDSTICK, BRUCE M (OD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:GOLDSTICK
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8801 TARTER AVE APT 1015
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6562
Mailing Address - Country:US
Mailing Address - Phone:806-352-4438
Mailing Address - Fax:806-352-5172
Practice Address - Street 1:7701 W INTERSTATE 40 STE 102
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-0102
Practice Address - Country:US
Practice Address - Phone:806-352-4438
Practice Address - Fax:806-352-5172
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX2792TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist