Provider Demographics
NPI:1962674606
Name:WAYNE GOLDEN OD PA
Entity Type:Organization
Organization Name:WAYNE GOLDEN OD PA
Other - Org Name:GOLDEN VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-342-9711
Mailing Address - Street 1:5045 FRUITVILLE RD STE 123
Mailing Address - Street 2:GOLDEN VISION
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2269
Mailing Address - Country:US
Mailing Address - Phone:941-342-9711
Mailing Address - Fax:941-378-3011
Practice Address - Street 1:5045 FRUITVILLE RD STE 123
Practice Address - Street 2:GOLDEN VISION
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2269
Practice Address - Country:US
Practice Address - Phone:941-342-9711
Practice Address - Fax:941-378-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2764332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4312140001Medicare NSC