Provider Demographics
NPI:1891232096
Name:WOODBRIDGE OPTOMETRY, INC.
Entity Type:Organization
Organization Name:WOODBRIDGE OPTOMETRY, INC.
Other - Org Name:WOODBRIDGE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-857-0676
Mailing Address - Street 1:4505 BARRANCA PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4707
Mailing Address - Country:US
Mailing Address - Phone:949-857-0676
Mailing Address - Fax:949-857-2175
Practice Address - Street 1:4505 BARRANCA PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4707
Practice Address - Country:US
Practice Address - Phone:949-857-0676
Practice Address - Fax:949-857-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9377TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty