Provider Demographics
NPI:1710335120
Name:WOODBRIDGE, DANIELLE (OD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WOODBRIDGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:SEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4070 CHICAGO DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1258
Mailing Address - Country:US
Mailing Address - Phone:616-531-3336
Mailing Address - Fax:
Practice Address - Street 1:4070 CHICAGO DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1258
Practice Address - Country:US
Practice Address - Phone:616-531-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist