Provider Demographics
NPI:1861484446
Name:GOLDEN, WAYNE (OD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 FRUITVILLE RD
Mailing Address - Street 2:# A-1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6410
Mailing Address - Country:US
Mailing Address - Phone:941-342-9711
Mailing Address - Fax:941-378-3011
Practice Address - Street 1:3277 FRUITVILLE RD # A-1
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6410
Practice Address - Country:US
Practice Address - Phone:941-342-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU51671FLMedicare UPIN
FL20519AMedicare ID - Type Unspecified