Provider Demographics
NPI:1437402732
Name:CLIFFORD L. WOOD O.D. P.A.
Entity Type:Organization
Organization Name:CLIFFORD L. WOOD O.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:I
Authorized Official - Credentials:OD
Authorized Official - Phone:850-547-3402
Mailing Address - Street 1:408 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-2731
Mailing Address - Country:US
Mailing Address - Phone:850-547-3402
Mailing Address - Fax:850-547-4113
Practice Address - Street 1:408 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2731
Practice Address - Country:US
Practice Address - Phone:850-547-3402
Practice Address - Fax:850-547-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty