Healthcare Provider Details

I. General information

NPI: 1932044567
Provider Name (Legal Business Name): LIGHTWORKS VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 GREEN PINE LN
VIRGINIA BEACH VA
23452-5902
US

IV. Provider business mailing address

3433 GREEN PINE LN
VIRGINIA BEACH VA
23452-5902
US

V. Phone/Fax

Practice location:
  • Phone: 718-938-3824
  • Fax: 718-682-3968
Mailing address:
  • Phone: 757-689-7923
  • Fax: 718-682-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON GOLDBERG
Title or Position: OWNER
Credential: MD
Phone: 757-689-7923