Individual
JAMES R GOLDSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1120 LAKE LAND BLVD, MATTOON, IL 61938-5562
(217) 258-8466
(217) 258-8443
Mailing address
1120 LAKE LAND BLVD, MATTOON, IL 61938-5562
(217) 258-8466
(217) 258-8443
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007322
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007322
—
IL
Enumeration date
10/11/2005
Last updated
10/20/2014
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