Provider Demographics
NPI:1912106097
Name:W. S. GOLDTHORPE, INC.
Entity type:Organization
Organization Name:W. S. GOLDTHORPE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDTHORPE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-742-7050
Mailing Address - Street 1:130 HENRY DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1105
Mailing Address - Country:US
Mailing Address - Phone:608-742-7050
Mailing Address - Fax:
Practice Address - Street 1:130 HENRY DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1105
Practice Address - Country:US
Practice Address - Phone:608-742-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0136410001Medicare NSC