Healthcare Provider Details

I. General information

NPI: 1316972995
Provider Name (Legal Business Name): ADAM D. GOLDSTONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44665 VALLEY CENTRAL WAY
LANCASTER CA
93536-6500
US

IV. Provider business mailing address

44665 VALLEY CENTRAL WAY
LANCASTER CA
93536-6500
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-7007
  • Fax:
Mailing address:
  • Phone: 661-942-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11051T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: