Provider Demographics
NPI:1376198713
Name:WOOLDRIDGE OPTOMETRY LLC
Entity Type:Organization
Organization Name:WOOLDRIDGE OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-332-2223
Mailing Address - Street 1:6470 E STATE ST STE 128
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2544
Mailing Address - Country:US
Mailing Address - Phone:815-332-2223
Mailing Address - Fax:815-717-7582
Practice Address - Street 1:6470 E STATE ST STE 128
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2544
Practice Address - Country:US
Practice Address - Phone:815-332-2223
Practice Address - Fax:815-717-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty