Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002545 | CT |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 002545 | CT |
N | 152WP0200X | Pediatric Optomitrist | 002545 | CT |
N | 152WS0006X | Sports Vision | 002545 | CT |
N | 152WV0400X | Optomitrist - Vision Therapist | 002545 | CT |
N | 152WX0102X | Occupational Vision | 002545 | CT |
NPI | 1013003615 |
---|---|
Provider Name | Dr. Michael Philip Goldstein |
First Address | Rocky Hill, CT 06067-1841 |
Second Address | Rocky Hill, CT 06067-1841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 30/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U86987 | (02) | CT |