Provider Demographics
NPI:1205005105
Name:WOODARD EYE CARE OD PLLC
Entity Type:Organization
Organization Name:WOODARD EYE CARE OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:REID
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-227-4448
Mailing Address - Street 1:WOODARD EYE CARE. OD, PLLC
Mailing Address - Street 2:PO BOX 1090
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253
Mailing Address - Country:US
Mailing Address - Phone:336-227-4448
Mailing Address - Fax:336-226-3926
Practice Address - Street 1:WOODARD EYE CARE
Practice Address - Street 2:304 S MAIN ST
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:336-227-4448
Practice Address - Fax:336-226-3926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODDARD EYE CARE. OD, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-25
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0434140001Medicare NSC