Provider Demographics
NPI:1962440156
Name:WOODEN, GWENDOLYN A (OD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:A
Last Name:WOODEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 LAUREL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:23881-8602
Mailing Address - Country:US
Mailing Address - Phone:301-908-6538
Mailing Address - Fax:804-526-5289
Practice Address - Street 1:1847B SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3607
Practice Address - Country:US
Practice Address - Phone:804-526-7830
Practice Address - Fax:804-526-5289
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist