Provider Demographics
NPI:1962767236
Name:GOLDBERG, ANNA (OD)
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 S 106TH PLZ
Mailing Address - Street 2:APT 404
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4784
Mailing Address - Country:US
Mailing Address - Phone:847-722-0531
Mailing Address - Fax:
Practice Address - Street 1:9851 S 71ST PLZ
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-2244
Practice Address - Country:US
Practice Address - Phone:402-686-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010577152W00000X
NE1433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE12414393OtherCAQH