MEDICARE: DR. JOSEPH G. GOLDBERG OD

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	I30001134	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV1667	OTHER	DC	MID ATLANTIC
2	510291543	OTHER	DE	UNITEDHEALTHCARE
3	4365417	OTHER	DE	AETNA

General Provider Information

NPI Number	:	1093772683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH G. GOLDBERG OD

Provider Business Mailing Address
First Line	:	801 E NEWPORT PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19804-1920
Country	:	US
Telephone Number	:	302-999-1286
Fax Number	:	302-999-1162

Provider Business Practice Location Address
First Line	:	801 E NEWPORT PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19804-1920
Country	:	US
Telephone Number	:	302-999-1286
Fax Number	:	302-999-1162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	06/12/2013

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