Provider Demographics
NPI:1689734543
Name:WOO, MABLE (OD)
Entity Type:Individual
Prefix:DR
First Name:MABLE
Middle Name:
Last Name:WOO
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 1:3120 E UNION HILLS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3421
Mailing Address - Country:US
Mailing Address - Phone:602-867-4200
Mailing Address - Fax:602-867-4450
Practice Address - Street 1:3120 E UNION HILLS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3421
Practice Address - Country:US
Practice Address - Phone:602-867-4200
Practice Address - Fax:602-867-4450
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ704371Medicaid
AZU87859Medicare UPIN
AZ67795Medicare ID - Type UnspecifiedOPTOMETRIST