Active NPI
Ellen Golden Goheen, LDO
- Optician
- Mulberry, FL
National Provider Identifier
1023708443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- DO3654
- Practice address
- 6745 N Church Ave
Mulberry, FL 33860-2080 - Phone
- (863) 581-2532
- Fax
- (863) 701-2595
- NPI assigned
- May 9, 2023
- Last updated
- May 9, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | DO3654 | FL | Primary |
Addresses
Primary practice location
6745 N Church Ave
Mulberry, FL 33860-2080
Mailing address
290 W Valencia Dr
Bartow, FL 33830-7155
Phone (863) 581-2532
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO3654 | FL | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683590400000",
"number": "1023708443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "290 W VALENCIA DR",
"city": "BARTOW",
"state": "FL",
"postal_code": "338307155",
"telephone_number": "863-581-2532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6745 N CHURCH AVE",
"city": "MULBERRY",
"state": "FL",
"postal_code": "338602080",
"telephone_number": "863-581-2532",
"fax_number": "863-701-2595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOHEEN",
"first_name": "ELLEN",
"middle_name": "GOLDEN",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-09",
"last_updated": "2023-05-09",
"certification_date": "2023-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "FL",
"license": "DO3654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mulberry, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.