Provider Demographics
NPI:1043513443
Name:WOOD, WILLIAM JAMES (AC ABOC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:WOOD
Suffix:
Gender:M
Credentials:AC ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 MANSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2821
Mailing Address - Country:US
Mailing Address - Phone:970-430-2006
Mailing Address - Fax:206-337-1379
Practice Address - Street 1:918 MANSFIELD DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2821
Practice Address - Country:US
Practice Address - Phone:970-430-2006
Practice Address - Fax:206-337-1379
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-1143156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician