Provider Demographics
NPI:1316156037
Name:DR.HARVEY GOLDSTONE, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR.HARVEY GOLDSTONE, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT HEAD OF OPERATIONS DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:GOLDSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-422-2020
Mailing Address - Street 1:2280 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3044
Mailing Address - Country:US
Mailing Address - Phone:562-422-2020
Mailing Address - Fax:562-426-2214
Practice Address - Street 1:2280 E CARSON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3044
Practice Address - Country:US
Practice Address - Phone:562-422-2020
Practice Address - Fax:562-426-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5273T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052730Medicaid
CASD0052730Medicaid
CAWY185Medicare UPIN
CAX98584Medicare UPIN