Provider Demographics
NPI:1154441525
Name:WOOD, AUDREY BRAZEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:BRAZEAL
Last Name:WOOD
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 1:1550 OPELIKA RD STE 6-347
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-7618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 30TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3012
Practice Address - Country:US
Practice Address - Phone:334-768-7202
Practice Address - Fax:334-768-3550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003377A152W00000X
IL046.010531152W00000X
ALSB02TA667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV02329Medicare UPIN
MO260701722Medicare PIN
MO260701723Medicare PIN