Provider Demographics
NPI:1447224969
Name:LEW-GOLTZ, JOANNE (OD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:LEW-GOLTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-0703
Mailing Address - Country:US
Mailing Address - Phone:415-845-5699
Mailing Address - Fax:
Practice Address - Street 1:1155 S CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6698
Practice Address - Country:US
Practice Address - Phone:970-385-1935
Practice Address - Fax:970-259-8901
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1493152W00000X
CO2589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO108431Medicare ID - Type Unspecified
COU71590Medicare UPIN