Provider Demographics
NPI:1417008178
Name:WOODS, MICHAEL PATRICK (O D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:WOODS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 VINTAGE VALLEY PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953
Mailing Address - Country:US
Mailing Address - Phone:509-865-2777
Mailing Address - Fax:509-865-4021
Practice Address - Street 1:915 VINTAGE VALLEY PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953
Practice Address - Country:US
Practice Address - Phone:509-865-2777
Practice Address - Fax:509-865-4021
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028918Medicaid
WA2028918Medicaid
WAG000119579Medicare PIN
WA0666450001Medicare NSC