1124148705 NPI number — DAVID DIXON GOLDEN, OD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124148705 NPI number — DAVID DIXON GOLDEN, OD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID DIXON GOLDEN, OD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER EYE CLINIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124148705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
702 LOUISIANA ST
Provider Second Line Business Mailing Address:
P. O. BOX 1838
Provider Business Mailing Address City Name:
CENTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75935-3672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-598-8501
Provider Business Mailing Address Fax Number:
936-598-2311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 LOUISIANA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75935-3672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-598-8501
Provider Business Practice Location Address Fax Number:
936-598-2311
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
DIXON
Authorized Official Title or Position:
OWNER OPTOMETRIST
Authorized Official Telephone Number:
936-598-8501

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410031769 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 081705801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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