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General NPI Number Information
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NPI Number | 1881109155
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Entity Type | Organization
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Legal Business Name | GOLDEN OPTICAL
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 15999 PINES BLVD UNIT 103
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1232
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Country | US
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Telephone | 754-400-7092
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Fax | 954-404-7197
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Provider Business Mailing Address
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Address Line | 15999 PINES BLVD UNIT 103
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1232
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Country | US
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Telephone | 754-400-7092
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Fax | 954-404-7197
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Authorized Official
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Title or Position | OPTICIAN/MANAGER
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Name | MR. BENJAMIN STRUM
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Credential | DO
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Telephone | 754-400-7092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | OE2405
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License Number State | FL
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