Provider Demographics
NPI:1154426526
Name:JOSHUA J.GOODEN, OPTOMETRIST, P.A.
Entity type:Organization
Organization Name:JOSHUA J.GOODEN, OPTOMETRIST, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-675-3938
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-0712
Mailing Address - Country:US
Mailing Address - Phone:620-872-0040
Mailing Address - Fax:620-872-0041
Practice Address - Street 1:804 MAIN
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740
Practice Address - Country:US
Practice Address - Phone:785-675-3938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651038Medicare ID - Type Unspecified
KSU72457Medicare UPIN