Provider Demographics
NPI:1508383381
Name:GOULDING EYECARE LLC
Entity Type:Organization
Organization Name:GOULDING EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GOULDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-217-7604
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-6170
Mailing Address - Country:US
Mailing Address - Phone:541-389-2508
Mailing Address - Fax:763-746-2096
Practice Address - Street 1:20120 PINEBROOK BLVD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2537
Practice Address - Country:US
Practice Address - Phone:541-389-2508
Practice Address - Fax:763-746-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3428AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty