NPIMap

Organization Active NPI

Paul R. Gollender, O.D.

  • Optometrist
  • Roseville, CA
National Provider Identifier
1619929890
Registry record updated Sep 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8998TG Issued in CA
Legal business name
PAUL R. GOLLENDER, O.D.
Practice address
1263 Pleasant Grove Blvd
Suite 100
Roseville, CA 95747-5858
Phone
(916) 786-8909
Fax
(916) 773-1195
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Paul Richard Gollender, O.D.NPI 1689861502
Title
Optometrist/Shareholder
Phone
(916) 786-8909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 8998TG CA Primary

Addresses

Primary practice location

1263 Pleasant Grove Blvd
Suite 100
Roseville, CA 95747-5858

Mailing address

1263 Pleasant Grove Blvd
Suite 100
Roseville, CA 95747-5858
Phone (916) 786-8909

Other identifiers 1

IdentifierTypeStateIssuer
SD0089980MedicaidCA

Other names 1

  • Renaissance Eye, A Professional Optometry Corporation Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190764800000",
    "number": "1619929890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1263 PLEASANT GROVE BLVD",
            "address_2": "SUITE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "957475858",
            "telephone_number": "916-786-8909",
            "fax_number": "916-773-1195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 PLEASANT GROVE BLVD",
            "address_2": "SUITE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "957475858",
            "telephone_number": "916-786-8909",
            "fax_number": "916-773-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL R. GOLLENDER, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2007-09-26",
        "status": "A",
        "authorized_official_last_name": "GOLLENDER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OPTOMETRIST/SHAREHOLDER",
        "authorized_official_telephone_number": "916-786-8909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8998TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0089980",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renaissance Eye, A Professional Optometry Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.