Provider Demographics
NPI:1073624755
Name:WOOD, JOHN ROLLAND (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROLLAND
Last Name:WOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2420
Mailing Address - Fax:248-528-2963
Practice Address - Street 1:740 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5277
Practice Address - Country:US
Practice Address - Phone:419-874-0393
Practice Address - Fax:419-874-0394
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHOPT.5669-THER152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2676215Medicaid
OHP00375231OtherRAILROAD MEDICARE
OHP00375231OtherRAILROAD MEDICARE