Provider Demographics
NPI:1205817087
Name:WOOD, AMANDA A (OD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:WOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:ANNE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:322 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-2106
Mailing Address - Country:US
Mailing Address - Phone:641-648-3306
Mailing Address - Fax:641-648-2075
Practice Address - Street 1:322 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-2106
Practice Address - Country:US
Practice Address - Phone:641-648-3306
Practice Address - Fax:641-648-2075
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA25604OtherWELLMARK BCBS IF
IA25608OtherWELLMARK BCBS P
IA3263772Medicaid
IA236571OtherMIDLAND'S CHOICE
IA4263772Medicaid
IA25604OtherWELLMARK BCBS IF
IA4263772Medicaid