Provider Demographics
NPI:1063835155
Name:DOCTOR GOLDENEYE, LLC
Entity Type:Organization
Organization Name:DOCTOR GOLDENEYE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:GALES
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-322-3777
Mailing Address - Street 1:PO BOX 34032
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4032
Mailing Address - Country:US
Mailing Address - Phone:775-322-3777
Mailing Address - Fax:775-376-1116
Practice Address - Street 1:SUITE VISION CENTER 2425 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1218
Practice Address - Country:US
Practice Address - Phone:775-322-3777
Practice Address - Fax:775-376-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty