Provider Demographics
NPI:1356595375
Name:GOLDENWOOD, INC.
Entity type:Organization
Organization Name:GOLDENWOOD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
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?:Yes
Parent Organization LBN:GOLDENWOOD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-05
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty