Provider Demographics
NPI:1538317979
Name:WOODWORTH, LAUREN SCHAMBS (OD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:SCHAMBS
Last Name:WOODWORTH
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 1:8313 S NC 55 HWY
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-9543
Mailing Address - Country:US
Mailing Address - Phone:919-639-2020
Mailing Address - Fax:919-639-8505
Practice Address - Street 1:8313 S NC 55 HWY
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-9543
Practice Address - Country:US
Practice Address - Phone:919-639-2020
Practice Address - Fax:919-639-8505
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910784Medicaid
NC5910784Medicaid