Provider Demographics
NPI:1689960635
Name:WOOD, RYNE CHRISTOPHER (OD)
Entity Type:Individual
Prefix:MR
First Name:RYNE
Middle Name:CHRISTOPHER
Last Name:WOOD
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 1:3230 BLATTNER DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6380
Mailing Address - Country:US
Mailing Address - Phone:573-334-2020
Mailing Address - Fax:573-334-2915
Practice Address - Street 1:3230 BLATTNER DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6380
Practice Address - Country:US
Practice Address - Phone:573-334-2020
Practice Address - Fax:573-334-2915
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5151490001Medicare NSC