Provider Demographics
NPI:1609009059
Name:DENNIS D GOLDEN OD PC INC
Entity Type:Organization
Organization Name:DENNIS D GOLDEN OD PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:903-693-7745
Mailing Address - Street 1:105 COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-1507
Mailing Address - Country:US
Mailing Address - Phone:903-693-7745
Mailing Address - Fax:903-693-8971
Practice Address - Street 1:105 COTTAGE RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-1507
Practice Address - Country:US
Practice Address - Phone:903-693-7745
Practice Address - Fax:903-693-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2493TG152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2493TGOtherLICENSE NO.
TX208167101Medicaid
TX1205927761OtherINDIVIDUAL NPI
TX0A4957Medicare PIN
TX2493TGOtherLICENSE NO.
TXT91055Medicare UPIN