Provider Demographics
NPI:1174855779
Name:KATHLEEN D. WOOSTER, O.D., P.A.
Entity Type:Organization
Organization Name:KATHLEEN D. WOOSTER, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:352-797-5505
Mailing Address - Street 1:924 CANDLELIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3116
Mailing Address - Country:US
Mailing Address - Phone:352-797-5505
Mailing Address - Fax:352-799-0462
Practice Address - Street 1:924 CANDLELIGHT BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3116
Practice Address - Country:US
Practice Address - Phone:352-797-5505
Practice Address - Fax:352-799-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty