Provider Demographics
NPI:1326089764
Name:SHELDON M. GOLDEN OD OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:SHELDON M. GOLDEN OD OPTOMETRIC CORPORATION
Other - Org Name:GOLDEN OPTOMETRIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-692-1208
Mailing Address - Street 1:11245 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-3111
Mailing Address - Country:US
Mailing Address - Phone:562-692-1208
Mailing Address - Fax:562-695-6386
Practice Address - Street 1:11245 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3111
Practice Address - Country:US
Practice Address - Phone:562-692-1208
Practice Address - Fax:562-695-6386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELDON M. GOLDEN OD OPTOMETRIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000250Medicaid
CAWY6068Medicare PIN
CA0259800001Medicare NSC
CA410012531Medicare PIN