=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073585410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLDEN OPTICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 W ORANGEBURG AVE
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-526-9883
-----------------------------------------------------
Fax | 209-526-8681
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 W ORANGEBURG AVE
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-526-9883
-----------------------------------------------------
Fax | 209-526-8681
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GARY R BAKER
-----------------------------------------------------
Credential | H.A. DISPENSER
-----------------------------------------------------
Telephone | 209-526-9883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 207
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------