Provider Demographics
NPI:1548202849
Name:GOLDEN HILLS OPTOMETRY, INC.
Entity Type:Organization
Organization Name:GOLDEN HILLS OPTOMETRY, INC.
Other - Org Name:GOLDEN HILLS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-274-9090
Mailing Address - Street 1:2690 S WHITE RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2098
Mailing Address - Country:US
Mailing Address - Phone:408-274-9090
Mailing Address - Fax:408-274-9120
Practice Address - Street 1:2690 S WHITE RD
Practice Address - Street 2:SUITE 255
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2098
Practice Address - Country:US
Practice Address - Phone:408-274-9090
Practice Address - Fax:408-274-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06880T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5601470001Medicare NSC
CAT10430Medicare UPIN
CASD0068800Medicare ID - Type UnspecifiedSERVICES BILLING NUMBER