Provider Demographics
NPI:1487824553
Name:STEPHEN WOOD, OD
Entity Type:Organization
Organization Name:STEPHEN WOOD, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-338-4091
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:KY
Mailing Address - Zip Code:42367-0100
Mailing Address - Country:US
Mailing Address - Phone:270-338-4091
Mailing Address - Fax:270-338-7913
Practice Address - Street 1:609 W MAIN
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367
Practice Address - Country:US
Practice Address - Phone:270-338-4091
Practice Address - Fax:270-338-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0407660001Medicare NSC