Provider Demographics
NPI:1518145127
Name:WOOD-YESLINE, CAITLIN (OD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WOOD-YESLINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 HWY 35
Mailing Address - Street 2:COSTCO OPTICAL
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1516
Mailing Address - Country:US
Mailing Address - Phone:732-264-4911
Mailing Address - Fax:
Practice Address - Street 1:2835 HWY 35
Practice Address - Street 2:COSTCO OPTICAL
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1516
Practice Address - Country:US
Practice Address - Phone:732-264-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00468200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist