Provider Demographics
NPI:1144220419
Name:WOOD, THOMAS B (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:WOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10660 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3432
Mailing Address - Country:US
Mailing Address - Phone:703-369-3937
Mailing Address - Fax:
Practice Address - Street 1:10660 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3432
Practice Address - Country:US
Practice Address - Phone:703-369-3937
Practice Address - Fax:703-369-7147
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-04-28
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
VA0618000305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0461900001Medicare NSC
VAT21962Medicare UPIN