Provider Demographics
NPI:1982742599
Name:GOLDBERG, HOWARD (OD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
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 1:24916 LAGUNA VIS
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7471
Mailing Address - Country:US
Mailing Address - Phone:949-922-9116
Mailing Address - Fax:949-606-8797
Practice Address - Street 1:2555 EL CAMINO REAL
Practice Address - Street 2:JC PENNEY OPTICAL
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1202
Practice Address - Country:US
Practice Address - Phone:760-729-4188
Practice Address - Fax:760-729-8136
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6235T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist