Provider Demographics
NPI:1053858027
Name:WOOD VISION CLINIC INC
Entity Type:Organization
Organization Name:WOOD VISION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:FAE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-456-4257
Mailing Address - Street 1:402 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1117
Mailing Address - Country:US
Mailing Address - Phone:641-456-4257
Mailing Address - Fax:641-456-3612
Practice Address - Street 1:402 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-1117
Practice Address - Country:US
Practice Address - Phone:641-456-4251
Practice Address - Fax:641-456-3612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOOD VISION CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty