Provider Demographics
NPI:1821120338
Name:MICHAEL P WOODS
Entity Type:Organization
Organization Name:MICHAEL P WOODS
Other - Org Name:YAKIMA VALLEY VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-452-9189
Mailing Address - Street 1:317 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3213
Mailing Address - Country:US
Mailing Address - Phone:509-452-9189
Mailing Address - Fax:509-452-9180
Practice Address - Street 1:317 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3213
Practice Address - Country:US
Practice Address - Phone:509-452-9189
Practice Address - Fax:509-452-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028918Medicaid