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General NPI Number Information
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NPI Number | 1255308177
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Entity Type | Individual
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Provider Name | JOSHUA J GOODEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 104 ALBERT AVE.
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City | SCOTT CITY
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State | KS
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Zip | 67871-1216
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Country | US
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Telephone | 620-872-0040
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 712 104 ALBERT AVE.
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City | SCOTT CITY
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State | KS
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Zip | 67871-1216
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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 |
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Name |
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Credential |
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Telephone |
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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 | 1528-3
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License Number State | KS
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