Provider Demographics
NPI:1851490445
Name:GOLDEN STATE EYE CENTER
Entity type:Organization
Organization Name:GOLDEN STATE EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAWANSY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-327-4499
Mailing Address - Street 1:1001 TOWER WAY
Mailing Address - Street 2:SUITE 150B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1586
Mailing Address - Country:US
Mailing Address - Phone:661-327-4499
Mailing Address - Fax:661-327-4381
Practice Address - Street 1:1001 TOWER WAY
Practice Address - Street 2:SUITE 150B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1586
Practice Address - Country:US
Practice Address - Phone:661-327-4499
Practice Address - Fax:661-327-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX16302Medicare UPIN