MEDICARE: INNA GOLDBERG OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1083776983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNA GOLDBERG OD PC

Provider Business Mailing Address
First Line	:	544 MILFORD
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4344
Country	:	US
Telephone Number	:	847-217-3797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1502
Country	:	US
Telephone Number	:	773-338-1290
Fax Number	:	773-338-0885

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. INNA GOLDBERG
Credential	:	OD
Telephone Number	:	847-217-3797

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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