Provider Demographics
NPI:1972823458
Name:GOLDEN, LAURA LEWIS (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEWIS
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ROSE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5736 MARIPOSA AVE
Mailing Address - Street 2:HOME ADDRESS
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7402
Mailing Address - Country:US
Mailing Address - Phone:916-591-9112
Mailing Address - Fax:
Practice Address - Street 1:5736 MARIPOSA AVE
Practice Address - Street 2:HOME ADDRESS
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7402
Practice Address - Country:US
Practice Address - Phone:916-591-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05729 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist