Basic Information
| Provider Information | |||||||||
| NPI: | 1992984991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIKTORIA GOLDENBERG,OD OPTOMETRY CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8554 DE SOTO AVE UNIT 44 | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913042993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238044794 | ||||||||
| FaxNumber: | 8187039079 | ||||||||
| Practice Location | |||||||||
| Address1: | 6433 FALLBROOK AVE | ||||||||
| Address2: | |||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913073543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187031410 | ||||||||
| FaxNumber: | 8187039079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2007 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | GOLDENBERG | ||||||||
| AuthorizedOfficialFirstName: | VIKTORIYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3238044794 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 12754T | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.