Active NPI
Randy Kenneth Goldman, OD
- Optometrist
- Needham, MA
National Provider Identifier
1366518011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2742
- Practice address
- 1211 Highland Ave
Needham, MA 02492 - Phone
- (781) 449-4090
- Fax
- (781) 449-0777
- NPI assigned
- Nov 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2742 | MA | Primary |
Addresses
Primary practice location
1211 Highland Ave
Needham, MA 02492
Mailing address
39 Philip Street
Medfield, MA 02052
Phone (508) 359-6401
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 762250 | Other | TUFTS | |
| T59299 | Other | EAST SENORITY | |
| W15573 | Other | BCBS | |
| 42930 | Other | DAVIS VISION | |
| 0343471 | Medicaid | MA | |
| MA2742 | Other | EYE MED |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040203000383 | MA | Practitioner - Optometry | 8123911328 | Practice locations: Needham, MA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2742 | MA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366518011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 PHILIP STREET",
"city": "MEDFIELD",
"state": "MA",
"postal_code": "02052",
"telephone_number": "508-359-6401",
"fax_number": "781-449-0777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 HIGHLAND AVE",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "02492",
"telephone_number": "781-449-4090",
"fax_number": "781-449-0777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDMAN",
"first_name": "RANDY",
"middle_name": "KENNETH",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "2742",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "762250",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EAST SENORITY",
"identifier": "T59299",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "W15573",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION",
"identifier": "42930",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0343471",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYE MED",
"identifier": "MA2742",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Needham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.