DOCTOR GOLDENEYE, LLC - NPI NUMBER 1063835155

Summary

Provider Name: DOCTOR GOLDENEYE, LLC

NPI Number: 1063835155

Clasification: Optometrist (152W00000X)

Address:
2425 E 2ND ST # 1
RENO, NV
ZIP 89502

Phone Number: (775) 359-8220



Detailed Information

DOCTOR GOLDENEYE, LLC is an optometrist in Reno, NV. The provider is doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. The assigned NPI number for this provider is 1063835155 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

2425 E 2ND ST # 1
RENO, NV
ZIP 89502-218
Phone: (775) 359-8220
Fax: (775) 348-8793

The provider's authorized official is Billy Mendoza .
The authorized official title is Primary Member and has the following contact phone number (775) 359-8220.

The enumeration date for this NPI number is 1/27/2014 and was last updated on 1/27/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 152W00000X Optometrist 671 NV Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1063835155 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name DOCTOR GOLDENEYE, LLC The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
5 Provider First Line Business Practice Location Address 2425 E 2ND ST # 1 The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name RENO The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address State Name NV The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 895021218 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 7753598220 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 7753488793 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 1/27/2014 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 1/27/2014 The date the provider was assigned a unique identifier (assigned an NPI).
14 Authorized Official Last Name MENDOZA The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name BILLY The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official Title or Position PRIMARY MEMBER The title or position of the authorized official.
17 Authorized Official Telephone Number 7753598220 The title or position of the authorized official.
18 Healthcare Provider Taxonomy Code 1 152W00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 671 Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number State Code 1 NV The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text DR.
24 Authorized Official Credential Text O.D.
25 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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1003053059 JEFFREY D. FERRIS, O.D., P.C. Organization Optometrist
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1194943167 DR. FRANCES JEAN SABOO, O.D. Individual Optometrist
1316955461 DR. JEAN CHARLES ERRAMOUPE, OD Individual Optometrist
1134203763 DR. JENNIFER L SHANE, O.D. Individual Optometrist
1093950834 DR. DAVID J BEECHER, O.D. Individual Optometrist


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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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