Provider Demographics
NPI:1952570020
Name:NICOLE A. GOLDING OD PA
Entity type:Organization
Organization Name:NICOLE A. GOLDING OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD PA
Authorized Official - Phone:850-385-0103
Mailing Address - Street 1:2506 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4026
Mailing Address - Country:US
Mailing Address - Phone:850-385-0103
Mailing Address - Fax:850-422-2950
Practice Address - Street 1:2506 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4026
Practice Address - Country:US
Practice Address - Phone:850-385-0103
Practice Address - Fax:850-422-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL OPC3470152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7271Medicare PIN