Provider Demographics
NPI:1811189731
Name:WOOLF EYE CLINIC, LTD
Entity Type:Organization
Organization Name:WOOLF EYE CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-969-1000
Mailing Address - Street 1:PO BOX 31447
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-1447
Mailing Address - Country:US
Mailing Address - Phone:480-969-1000
Mailing Address - Fax:480-644-0869
Practice Address - Street 1:2855 E BROWN RD
Practice Address - Street 2:SUITE #10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-4213
Practice Address - Country:US
Practice Address - Phone:480-969-1000
Practice Address - Fax:480-644-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12396174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204199-001Medicaid
CS0717OtherRAILROAD MEDICARE
AZAZ0029640OtherBLUE CROSS BLUE SHIELD
D00579Medicare UPIN
AZZWMBRHMedicare PIN