Provider Demographics
NPI:1619024916
Name:WOODMAN, WILLIAM R (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:WOODMAN
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 1:1900 NE 3RD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3854
Mailing Address - Country:US
Mailing Address - Phone:541-385-5848
Mailing Address - Fax:541-330-0988
Practice Address - Street 1:1900 NE 3RD ST STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3854
Practice Address - Country:US
Practice Address - Phone:541-385-5848
Practice Address - Fax:541-330-0988
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2164ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023270Medicaid
ORR112501Medicare PIN
OR023270Medicaid
ORU02035Medicare UPIN