Provider Demographics
NPI:1851442818
Name:ROBERT E WOODRUFF, II, OD, INC.
Entity Type:Organization
Organization Name:ROBERT E WOODRUFF, II, OD, INC.
Other - Org Name:BUCKEYECARE OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:330-468-0585
Mailing Address - Street 1:8051 VESTA AVE
Mailing Address - Street 2:STE # 2
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2080
Mailing Address - Country:US
Mailing Address - Phone:330-468-0585
Mailing Address - Fax:330-468-1083
Practice Address - Street 1:8051 VESTA AVE
Practice Address - Street 2:STE # 2
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2080
Practice Address - Country:US
Practice Address - Phone:330-468-0585
Practice Address - Fax:330-468-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3445T708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========00OtherBWC
0161090001Medicare NSC