Provider Demographics
NPI:1467583468
Name:WOODY, DAVID THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:WOODY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1507
Mailing Address - Country:US
Mailing Address - Phone:502-348-8584
Mailing Address - Fax:502-348-4695
Practice Address - Street 1:311 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1507
Practice Address - Country:US
Practice Address - Phone:502-348-8584
Practice Address - Fax:502-348-4695
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1248DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049974OtherUNICARE PROVIDER NUMBER
KY000000049974OtherANTHEM PROVIDER NUMBER
KY77012482Medicaid
KY911296OtherPASSPORT PROVIDER NUMBER
KY410023108OtherRAILROAD MEDICARE NUMBER
KY4673505OtherAETNA PROVIDER NUMBER
KY11314OtherUNITED HEALTH CARE
KY410023108OtherRAILROAD MEDICARE NUMBER
KYU35455Medicare UPIN