Provider Demographics
NPI:1902122864
Name:GOLDEN GOOSE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:GOLDEN GOOSE ENTERPRISES, INC.
Other - Org Name:OPTICAL MATTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOSLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-730-7422
Mailing Address - Street 1:7539 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3179
Mailing Address - Country:US
Mailing Address - Phone:303-730-7422
Mailing Address - Fax:303-730-7407
Practice Address - Street 1:7539 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3179
Practice Address - Country:US
Practice Address - Phone:303-730-7422
Practice Address - Fax:303-730-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU40239Medicare UPIN
COCOA102123Medicare PIN