Provider Demographics
NPI:1235300161
Name:W T WOOD OD PA
Entity Type:Organization
Organization Name:W T WOOD OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-489-5907
Mailing Address - Street 1:26 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2811
Mailing Address - Country:US
Mailing Address - Phone:662-489-5907
Mailing Address - Fax:662-489-6928
Practice Address - Street 1:26 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2811
Practice Address - Country:US
Practice Address - Phone:662-489-5907
Practice Address - Fax:662-489-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087916Medicaid
MS00087916Medicaid
MS0652140001Medicare NSC