Healthcare Provider Details

I. General information

NPI: 1649216672
Provider Name (Legal Business Name): SHELDON M. GOLDEN OD, OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 W WEST COVINA PKWY STE B
WEST COVINA CA
91790-2810
US

IV. Provider business mailing address

1026 W WEST COVINA PKWY STE B
WEST COVINA CA
91790-2810
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-5868
  • Fax: 626-856-0570
Mailing address:
  • Phone: 626-962-5868
  • Fax: 626-856-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8726
License Number StateCA

VIII. Authorized Official

Name: CAROL MOORE
Title or Position: INSURANCE ADMINISTRATOR
Credential:
Phone: 626-962-5868