Provider Demographics
NPI:1235105461
Name:WOODRUFF, SCOTT E (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:WOODRUFF
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 1:371 NE GARDEN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2039
Mailing Address - Country:US
Mailing Address - Phone:541-673-4166
Mailing Address - Fax:541-673-0029
Practice Address - Street 1:371 NE GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2039
Practice Address - Country:US
Practice Address - Phone:541-673-4166
Practice Address - Fax:541-673-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1218AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT68285Medicare UPIN
ORR113352Medicare PIN