Provider Demographics
NPI:1841236064
Name:GOLDEN EYE OPTICAL LLC
Entity Type:Organization
Organization Name:GOLDEN EYE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-922-2311
Mailing Address - Street 1:1068 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-4102
Mailing Address - Country:US
Mailing Address - Phone:303-922-2311
Mailing Address - Fax:
Practice Address - Street 1:1068 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4102
Practice Address - Country:US
Practice Address - Phone:303-922-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99166799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25707272Medicaid
CO25707272Medicaid
COC46093Medicare ID - Type Unspecified