=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609009059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENNIS D GOLDEN OD PC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2009
-----------------------------------------------------
Last Update Date | 03/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 COTTAGE RD
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75633-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-693-7745
-----------------------------------------------------
Fax | 903-693-8971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 COTTAGE RD
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75633-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-693-7745
-----------------------------------------------------
Fax | 903-693-8971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. DENNIS D GOLDEN SR.
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 903-693-7745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2493TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------