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General NPI Number Information
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NPI Number | 1962767236
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Entity Type | Individual
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Provider Name | ANNA GOLDBERG O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 9851 S 71ST PLZ
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City | PAPILLION
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State | NE
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Zip | 68133-2244
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Country | US
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Telephone | 402-686-2396
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Fax |
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Provider Business Mailing Address
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Address Line | 1039 S 106TH PLZ APT 404
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City | OMAHA
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State | NE
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Zip | 68114-4784
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Country | US
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Telephone | 847-722-0531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010577
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1433
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License Number State | NE
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