Provider Demographics
NPI:1689861502
Name:GOLLENDER, PAUL RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:GOLLENDER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1263 PLEASANT GROVE BLVD
Mailing Address - Street 2:#100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5884
Mailing Address - Country:US
Mailing Address - Phone:916-786-8909
Mailing Address - Fax:916-772-1187
Practice Address - Street 1:1263 PLEASANT GROVE BLVD
Practice Address - Street 2:#100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5884
Practice Address - Country:US
Practice Address - Phone:916-786-8909
Practice Address - Fax:916-772-1187
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT8998TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T88799Medicare UPIN
CASD008991Medicare PIN