MEDICARE: DR. HOWARD GOLDBERG O.D.

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	6235T	CA

General Provider Information

NPI Number	:	1982742599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD GOLDBERG O.D.

Provider Business Mailing Address
First Line	:	24916 LAGUNA VIS
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7471
Country	:	US
Telephone Number	:	949-922-9116
Fax Number	:	949-606-8797

Provider Business Practice Location Address
First Line	:	2555 EL CAMINO REAL
Second Line	:	JC PENNEY OPTICAL
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1202
Country	:	US
Telephone Number	:	760-729-4188
Fax Number	:	760-729-8136

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

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	07/08/2007

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