Provider Demographics
NPI:1821081340
Name:WOODRUFF, ROBERT DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:WOODRUFF
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 1:2665 FOX POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3222
Mailing Address - Country:US
Mailing Address - Phone:812-379-9893
Mailing Address - Fax:812-379-9904
Practice Address - Street 1:2665 FOX POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3222
Practice Address - Country:US
Practice Address - Phone:812-379-9893
Practice Address - Fax:812-379-9904
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001592A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100159260Medicaid
IN436740Medicare ID - Type Unspecified
IN100159260Medicaid
INT34806Medicare UPIN