Provider Demographics
NPI:1609868868
Name:WOOLF OPTOMETRIST PC, PAUL L (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:WOOLF OPTOMETRIST PC
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1660 N HIGLEY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1614
Mailing Address - Country:US
Mailing Address - Phone:480-830-1212
Mailing Address - Fax:480-830-0029
Practice Address - Street 1:1660 N HIGLEY RD
Practice Address - Street 2:STE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1614
Practice Address - Country:US
Practice Address - Phone:480-830-1212
Practice Address - Fax:480-830-0029
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ879152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU49254Medicare UPIN
AZZ121109Medicare PIN