Provider Demographics
NPI:1871681346
Name:GOLDBERG, STEVEN MARC (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARC
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14314 COBBLE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2823
Mailing Address - Country:US
Mailing Address - Phone:314-629-7667
Mailing Address - Fax:314-205-1107
Practice Address - Street 1:14314 COBBLE CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2823
Practice Address - Country:US
Practice Address - Phone:314-629-7667
Practice Address - Fax:314-205-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist