Provider Demographics
NPI:1073585410
Name:HOLDEN OPTICAL INC.
Entity Type:Organization
Organization Name:HOLDEN OPTICAL INC.
Other - Org Name:HOLDLEN HEARING AID SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:HA DISPENSER
Authorized Official - Phone:209-526-9883
Mailing Address - Street 1:1150 W ORANGEBURG AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4042
Mailing Address - Country:US
Mailing Address - Phone:209-526-9883
Mailing Address - Fax:209-526-8681
Practice Address - Street 1:1150 W ORANGEBURG AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4042
Practice Address - Country:US
Practice Address - Phone:209-526-9883
Practice Address - Fax:209-526-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71978ZMedicaid
CAZZZ71978ZMedicaid