Provider Demographics
NPI:1407859135
Name:WOOD, THOMAS STACY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STACY
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5494 GLEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4308
Mailing Address - Country:US
Mailing Address - Phone:214-692-6220
Mailing Address - Fax:214-696-1579
Practice Address - Street 1:5494 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4308
Practice Address - Country:US
Practice Address - Phone:214-692-6220
Practice Address - Fax:214-696-1579
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9017207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180014986OtherRAILROAD MEDICARE
TX122821503Medicaid
TX122821505Medicaid
TX122821503Medicaid
TX8E0496Medicare PIN
TX180014986OtherRAILROAD MEDICARE
TX0926270001OtherPALMETTO GBA
TX89W931OtherHMO BLUE
TX122821503Medicaid
TX180014986OtherRAILROAD MEDICARE
TXE22373Medicare UPIN