Provider Demographics
NPI:1518023662
Name:WOOD, LINDA NUCKOLS
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:NUCKOLS
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 HEMLOCK TRL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:VA
Mailing Address - Zip Code:24574-3041
Mailing Address - Country:US
Mailing Address - Phone:434-922-7085
Mailing Address - Fax:434-845-1993
Practice Address - Street 1:999 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2141
Practice Address - Country:US
Practice Address - Phone:434-846-3937
Practice Address - Fax:434-845-1993
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001254156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician