Provider Demographics
NPI:1508885245
Name:WOOD, THURMAN E (OD)
Entity Type:Individual
Prefix:
First Name:THURMAN
Middle Name:E
Last Name:WOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4819 CALLOWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5691
Mailing Address - Country:US
Mailing Address - Phone:661-325-7739
Mailing Address - Fax:661-325-2731
Practice Address - Street 1:4819 CALLOWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5691
Practice Address - Country:US
Practice Address - Phone:661-325-7739
Practice Address - Fax:661-325-2731
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9498T152WC0802X, 152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU58774Medicare UPIN
CA4885940001Medicare NSC
CASD0094980 CAMedicare PIN