Provider Demographics
NPI:1871066878
Name:WOOD FAMILY EYECARE OD LLC
Entity type:Organization
Organization Name:WOOD FAMILY EYECARE OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-420-2251
Mailing Address - Street 1:1550 OPELIKA RD STE 6-347
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-7618
Mailing Address - Country:US
Mailing Address - Phone:314-420-2251
Mailing Address - Fax:
Practice Address - Street 1:2005 30TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3012
Practice Address - Country:US
Practice Address - Phone:334-768-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154441525OtherINDIVIDUAL NPI