Golden Skillet, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

GOLDEN SKILLET, LLC

Practice address

703 Christopher Dr
Belen, NM 87002-2617

Phone

(505) 864-7781

NPI assigned

Aug 8, 2022

Last updated

Aug 8, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John William Dieterichs

Title

Owner

Phone

(505) 859-5934

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659916800000",
    "number": "1215665377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 JACK NICKLAUS DR",
            "city": "RIO COMMUNITIES",
            "state": "NM",
            "postal_code": "870025925",
            "telephone_number": "505-859-5934",
            "fax_number": "505-212-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 CHRISTOPHER DR",
            "city": "BELEN",
            "state": "NM",
            "postal_code": "870022617",
            "telephone_number": "505-864-7781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN SKILLET, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-08",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A",
        "authorized_official_last_name": "DIETERICHS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-859-5934"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW MEXICO CRS",
            "identifier": "03582434004",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "GoldenSkillet54@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "703 Christopher Dr",
            "city": "Belen",
            "state": "NM",
            "country_code": "US",
            "postal_code": "870022617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Marie Garcia
• Joseph Ryan Garcia, BSN RN
• Mary Garcia
• Mark Garnand
• Dusty Lauren Gentry, FNP-C
• Alisa Gonzales, CCSS
• Christopher Gonzales, CSW
• Delilah Gonzales
• Gabriel Gonzales
• Eirete Gonzalez

• Optometrist in Belen, NM
• Providers in Belen, NM by specialty
• Optometrist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.