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General NPI Number Information
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NPI Number | 1154426526
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Entity Type | Organization
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Legal Business Name | JOSHUA J.GOODEN, OPTOMETRIST, P.A.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 804 MAIN
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City | HOXIE
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State | KS
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Zip | 67740
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Country | US
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Telephone | 785-675-3938
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 712
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City | SCOTT CITY
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State | KS
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Zip | 67871-0712
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Country | US
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Telephone | 620-872-0040
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Fax | 620-872-0041
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOSHUA J. GOODEN
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Credential | O.D.
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Telephone | 785-675-3938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1528
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License Number State | KS
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