Provider Demographics
NPI:1821115882
Name:WOOD, NORMAN E (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:E
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 1:368 GRASS HILL RD
Mailing Address - Street 2:
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-2403
Mailing Address - Country:US
Mailing Address - Phone:803-625-3440
Mailing Address - Fax:803-625-3579
Practice Address - Street 1:2010 BROWNING GATE RD
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-2428
Practice Address - Country:US
Practice Address - Phone:803-625-3384
Practice Address - Fax:803-625-3579
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD03592Medicaid
SCT245267252Medicare ID - Type UnspecifiedMEDICARE
SCD03592Medicaid