Provider Demographics
NPI:1861450181
Name:WOODCOME, HENRY E (OD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:E
Last Name:WOODCOME
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 1:63 MAIN ST
Mailing Address - Street 2:ATTN: VIRGILIA PIRES
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4042
Mailing Address - Country:US
Mailing Address - Phone:508-894-3503
Mailing Address - Fax:508-559-5073
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:BROCKTON NEIGHBORHOOD HEALTH CENTER
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4042
Practice Address - Country:US
Practice Address - Phone:508-894-3503
Practice Address - Fax:508-559-5073
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026097302OtherUNIVERA # LTH
NY101944CSOtherPREFERRED CARE # LTH
NYP010003495OtherBLUE CHOICE # LTH
NYRA5783Medicare ID - Type Unspecified
U42281Medicare UPIN