Provider Demographics
NPI:1104154079
Name:GOLDEN NORTH OPTICS, INC
Entity type:Organization
Organization Name:GOLDEN NORTH OPTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED DISPENSING OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:907-456-4822
Mailing Address - Street 1:1521 STACIA ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6135
Mailing Address - Country:US
Mailing Address - Phone:907-456-4822
Mailing Address - Fax:907-456-4830
Practice Address - Street 1:1521 STACIA ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6135
Practice Address - Country:US
Practice Address - Phone:907-456-4822
Practice Address - Fax:907-456-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK248156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty