Provider Demographics
NPI:1447421292
Name:WILLIAM R WOODMAN O.D. PC
Entity Type:Organization
Organization Name:WILLIAM R WOODMAN O.D. PC
Other - Org Name:PREFERRED OPTICAL/SISTERS VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-385-5848
Mailing Address - Street 1:1900 NE 3RD STREET, STE 102
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3854
Mailing Address - Country:US
Mailing Address - Phone:541-385-5848
Mailing Address - Fax:541-330-0988
Practice Address - Street 1:1900 NE 3RD STREET, STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3854
Practice Address - Country:US
Practice Address - Phone:541-385-5848
Practice Address - Fax:541-330-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2164ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061085Medicaid
ORR112489Medicare PIN
OR4390720001Medicare NSC
OR061085Medicaid