Provider Demographics
NPI:1982686002
Name:GOLESH, EDWARD J (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:GOLESH
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 1:7447 E ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1200
Mailing Address - Country:US
Mailing Address - Phone:303-770-8081
Mailing Address - Fax:303-770-1642
Practice Address - Street 1:7447 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1200
Practice Address - Country:US
Practice Address - Phone:303-770-8081
Practice Address - Fax:303-770-1642
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U26673Medicare UPIN
COD0123Medicare ID - Type Unspecified