Provider Demographics
NPI:1194092452
Name:THOMAS J GOLDSTEIN, OD, PA
Entity type:Organization
Organization Name:THOMAS J GOLDSTEIN, OD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-647-3443
Mailing Address - Street 1:6301 NW LOOP 410
Mailing Address - Street 2:SUITE N-1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3824
Mailing Address - Country:US
Mailing Address - Phone:210-647-3443
Mailing Address - Fax:210-647-7600
Practice Address - Street 1:6301 NW LOOP 410
Practice Address - Street 2:SUITE N-1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3824
Practice Address - Country:US
Practice Address - Phone:210-647-3443
Practice Address - Fax:210-647-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier