Provider Demographics
NPI:1902076813
Name:GOLDEN VISION CLINIC PC
Entity Type:Organization
Organization Name:GOLDEN VISION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-278-2020
Mailing Address - Street 1:2301 FORD ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2427
Mailing Address - Country:US
Mailing Address - Phone:303-278-2020
Mailing Address - Fax:
Practice Address - Street 1:2301 FORD ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2427
Practice Address - Country:US
Practice Address - Phone:303-278-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC77033Medicare PIN
CO0532770001Medicare NSC