Provider Demographics
NPI:1902006083
Name:FREDERICK A. WOOD
Entity Type:Organization
Organization Name:FREDERICK A. WOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:607-273-4231
Mailing Address - Street 1:134 THE COMMONS
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5542
Mailing Address - Country:US
Mailing Address - Phone:607-273-4231
Mailing Address - Fax:607-273-4654
Practice Address - Street 1:134 THE COMMONS
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5542
Practice Address - Country:US
Practice Address - Phone:607-273-4231
Practice Address - Fax:607-273-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 3413152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0128860001Medicare NSC
NY39832AMedicare PIN