MEDICARE: DR. ROBERT 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	TUV003814	NY

General Provider Information

NPI Number	:	1235297037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GOLDBERG O.D.

Provider Business Mailing Address
First Line	:	425 LEXINGTON AVE
Second Line	:	EASTSIDE OPTOMETRIC, P.C. CO LENSCRAFTERS
City	:	NEW YORK
State	:	NY
Zip	:	10017-3903
Country	:	US
Telephone Number	:	212-986-9281
Fax Number	:	212-681-6102

Provider Business Practice Location Address
First Line	:	425 LEXINGTON AVE
Second Line	:	EASTSIDE OPTOMETRIC, P.C. CO LENSCRAFTERS
City	:	NEW YORK
State	:	NY
Zip	:	10017-3903
Country	:	US
Telephone Number	:	212-986-9281
Fax Number	:	212-681-6102

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/14/2007

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