Provider Demographics
NPI:1851327449
Name:GOLDEN ROWLAND HEIGHTS OPTOMETRY
Entity Type:Organization
Organization Name:GOLDEN ROWLAND HEIGHTS OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-965-8698
Mailing Address - Street 1:1015 NOGALES ST
Mailing Address - Street 2:#109
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1360
Mailing Address - Country:US
Mailing Address - Phone:626-965-8698
Mailing Address - Fax:626-965-8697
Practice Address - Street 1:1015 NOGALES ST
Practice Address - Street 2:#109
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1360
Practice Address - Country:US
Practice Address - Phone:626-965-8698
Practice Address - Fax:626-965-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004100Medicaid
CAW15532Medicare PIN
CAW15532Medicare ID - Type UnspecifiedMEDICARE GROUP #