Provider Demographics
NPI:1912991100
Name:GOLDBERG, LAWRENCE H (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:H
Last Name:GOLDBERG
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 1:102 COMMONWEALTH CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4400
Mailing Address - Country:US
Mailing Address - Phone:919-469-8868
Mailing Address - Fax:919-469-5010
Practice Address - Street 1:102 COMMONWEALTH CT
Practice Address - Street 2:SUITE D
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4400
Practice Address - Country:US
Practice Address - Phone:919-469-8868
Practice Address - Fax:919-469-5010
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1168152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890905CMedicaid
NC246627Medicare ID - Type Unspecified
NC890905CMedicaid