Provider Demographics
NPI:1629417480
Name:WOOLVERTON, BRENT ALDEN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALDEN
Last Name:WOOLVERTON
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:28301 STATE HIGHWAY 249 STE 700
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6559
Practice Address - Country:US
Practice Address - Phone:281-351-2020
Practice Address - Fax:281-516-9900
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2021-11-18
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Provider Licenses
StateLicense IDTaxonomies
TX8193T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist