Organization
JOSHUA J. GOODEN, OPTOMETRIST, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA J. GOODEN O.D. (OPTOMETRIST)
(620) 872-0040
Entity
Organization
Contact information
Practice address
104 ALBERT AVE., SCOTT CITY, KS 67871-1216
(620) 872-0040
(620) 872-0041
Mailing address
PO BOX 712, SCOTT CITY, KS 67871-0712
(620) 872-0040
(620) 872-0041
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1528
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100325510C
—
KS
01
—
410039905
RR MEDICARE
KS
Enumeration date
08/31/2006
Last updated
02/26/2013
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