Provider Demographics
NPI:1295980233
Name:JOSHUA WOODLAND
Entity type:Organization
Organization Name:JOSHUA WOODLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-927-3759
Mailing Address - Street 1:105 E BUTLER ST
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1606
Mailing Address - Country:US
Mailing Address - Phone:563-927-3759
Mailing Address - Fax:563-927-5582
Practice Address - Street 1:3247 23RD AVE.
Practice Address - Street 2:(INSIDE SAMS CLUB)
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620
Practice Address - Country:US
Practice Address - Phone:970-330-0313
Practice Address - Fax:970-330-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty