Provider Demographics
NPI:1083745095
Name:WOODY, LISA SLOAN (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SLOAN
Last Name:WOODY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1507
Mailing Address - Country:US
Mailing Address - Phone:502-348-8584
Mailing Address - Fax:502-348-4695
Practice Address - Street 1:311 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1507
Practice Address - Country:US
Practice Address - Phone:502-348-8584
Practice Address - Fax:502-348-4695
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1249DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4638260OtherAETNA PROVIDER NUMBER
KY000000337829OtherANTHEM PROVIDER NUMBER
KY77012490Medicaid
KY000000337829OtherUNICARE PROVIDER NUMBER
KY11312OtherUNITED HEALTH CARE
KY410024016OtherRAILROAD MEDICARE
KY911295OtherPASSPORT PROVIDER NUMBER
KY9320401Medicare PIN
KY000000337829OtherANTHEM PROVIDER NUMBER
KY911295OtherPASSPORT PROVIDER NUMBER