Inna Goldberg OD PC
Organization Active NPI Optometrist · Chicago, IL
NPI 1083776983 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1083776983
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- INNA GOLDBERG OD PC
- Practice address
- 2822 W Devon Ave
Chicago, IL 60659-1502 - Phone
- (773) 338-1290
- Fax
- (773) 338-0885
- NPI assigned
- Dec 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Inna Goldberg, OD
- Title
- President
- Phone
- (847) 217-3797
Practitioners 1
-
Inna Goldberg, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040812000817 | IL | Part B Supplier - Clinic/Group Practice | 2567434111 |
Receives reassigned benefits from 1 practitioner Practice locations: River Grove, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | IL | Yes |
Addresses
Primary practice location
2822 W Devon Ave
Chicago, IL 60659-1502
Mailing address
544 Milford
Deerfield, IL 60015-4344
Phone (847) 217-3797
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.