=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215914478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN MACARTHUR GOODE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W MAGNOLIA AVE #100
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-7644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-332-4005
-----------------------------------------------------
Fax | 817-332-4039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 W MAGNOLIA AVE 100
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-7644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-332-4005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0009X
-----------------------------------------------------
Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | G3400
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G3400
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------