Provider Demographics
NPI:1205927761
Name:GOLDEN, DENNIS D SR (OD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:GOLDEN
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633
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
Practice Address - Country:US
Practice Address - Phone:903-693-7745
Practice Address - Fax:903-693-8971
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2493TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2493TGOtherLICENSE NO
TX121637605Medicaid
T91055Medicare UPIN
TX121637601Medicaid
TX0367920001Medicare NSC