Provider Demographics
NPI:1932334497
Name:DAVID M. GOLDBERG, O.D., P.C.
Entity Type:Organization
Organization Name:DAVID M. GOLDBERG, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-750-1585
Mailing Address - Street 1:6301 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5044
Mailing Address - Country:US
Mailing Address - Phone:703-750-1585
Mailing Address - Fax:703-750-1587
Practice Address - Street 1:6301 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 110
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5044
Practice Address - Country:US
Practice Address - Phone:703-750-1585
Practice Address - Fax:703-750-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
242447OtherMAMSI/UNITED HEALTHCARE
VA010023238Medicaid
VA43671OtherDAVIS VISION
VA2028250OtherAETNA
VAVA0863OtherEYEMED
VA2028250OtherAETNA
VA2028250OtherAETNA
VAT30893Medicare UPIN
VAVA0863OtherEYEMED