Provider Demographics
NPI:1598744005
Name:GOLDSTEIN, THOMAS J (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:GOLDSTEIN
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 1:3331 WURZBACH RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-5138
Mailing Address - Country:US
Mailing Address - Phone:210-520-6353
Mailing Address - Fax:210-522-0606
Practice Address - Street 1:1136 MAIN ST
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-3589
Practice Address - Country:US
Practice Address - Phone:830-850-0628
Practice Address - Fax:830-850-0346
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4652TG152W00000X
OK1134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1216616-02Medicaid
TX00E92TMedicare ID - Type Unspecified
TX1216616-02Medicaid