Provider Demographics
NPI:1518173749
Name:WOOD, STEVEN A (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:WOOD
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 1:255 E WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2706
Mailing Address - Country:US
Mailing Address - Phone:209-466-5566
Mailing Address - Fax:209-466-0535
Practice Address - Street 1:255 E WEBER AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2706
Practice Address - Country:US
Practice Address - Phone:209-466-5566
Practice Address - Fax:209-466-0535
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6385TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU668VMedicare PIN
CABU668PMedicare PIN
CABU668QMedicare PIN
CAT10307Medicare UPIN
CABU668YMedicare PIN
CABU668RMedicare PIN
CABU668XMedicare PIN