Provider Demographics
NPI:1093774572
Name:GOLDENWOOD
Entity Type:Organization
Organization Name:GOLDENWOOD
Other - Org Name:AVENUE VISION/BERGEN PARK VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRUST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STRUBE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-279-3713
Mailing Address - Street 1:1208 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1145
Mailing Address - Country:US
Mailing Address - Phone:303-279-3713
Mailing Address - Fax:303-273-5823
Practice Address - Street 1:1208 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1145
Practice Address - Country:US
Practice Address - Phone:303-279-3713
Practice Address - Fax:303-273-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1109152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty