MEDICARE: STEVEN I GOODMAN 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	152WC0802X	Corneal and Contact Management Optometrist	VUT005113	NY
2	152WL0500X	Low Vision Rehabilitation Optometrist	VUT005113	NY
3	152WP0200X	Pediatric Optometrist	VUT005113	NY
4	152WS0006X	Sports Vision Optometrist	VUT005113	NY
5	152WV0400X	Vision Therapy Optometrist	VUT005113	NY
6	152WX0102X	Occupational Vision Optometrist	VUT005113	NY
7	152W00000X	Optometrist	VUT005113	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992707491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN I GOODMAN OD PC

Provider Business Mailing Address
First Line	:	1643 ROUTE 112 STE A
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-3654
Country	:	US
Telephone Number	:	631-758-5575
Fax Number	:	631-758-5579

Provider Business Practice Location Address
First Line	:	1643 ROUTE 112 STE A
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-3654
Country	:	US
Telephone Number	:	631-758-5575
Fax Number	:	631-758-5579

Authorized Official
Title or Position	:	DR.
Name	:	DR. STEVEN I GOODMAN
Credential	:	O.D.
Telephone Number	:	631-758-5575

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/02/2017

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