Provider Demographics
NPI:1013030964
Name:WOOD, WILLIAM TERRY
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TERRY
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2822
Mailing Address - Country:US
Mailing Address - Phone:662-489-5907
Mailing Address - Fax:662-489-6928
Practice Address - Street 1:26 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2811
Practice Address - Country:US
Practice Address - Phone:662-489-5907
Practice Address - Fax:662-489-6928
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0652140001OtherCIGNA GOVERNMENT
MS00087916Medicaid
MS00087916Medicaid
MS0652140001OtherCIGNA GOVERNMENT