Provider Demographics
NPI:1982769246
Name:GOLDBOSS, DANIEL E (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:GOLDBOSS
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 1:1811 UNIVERSITY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-7774
Mailing Address - Country:US
Mailing Address - Phone:760-726-4074
Mailing Address - Fax:
Practice Address - Street 1:1811 UNIVERSITY DR STE 102
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7774
Practice Address - Country:US
Practice Address - Phone:760-726-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP10974Medicare ID - Type Unspecified
CAU88045Medicare UPIN