Provider Demographics
NPI:1033182829
Name:WOOD, JOHN WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:WOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:252 W LOS ANGELES AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1888
Mailing Address - Country:US
Mailing Address - Phone:805-529-5497
Mailing Address - Fax:805-529-4987
Practice Address - Street 1:252 W LOS ANGELES AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1888
Practice Address - Country:US
Practice Address - Phone:805-529-5497
Practice Address - Fax:805-529-4987
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7093T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH492OtherPTAN
CABH492OtherPTAN
CABH492OtherPTAN