Provider Demographics
NPI:1942252820
Name:WOOD, JENNIFER D (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:WOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 RIVERY BLVD STE 2005
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3064
Mailing Address - Country:US
Mailing Address - Phone:512-686-3424
Mailing Address - Fax:737-253-8333
Practice Address - Street 1:1500 RIVERY BLVD STE 2005
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3064
Practice Address - Country:US
Practice Address - Phone:512-686-3424
Practice Address - Fax:737-253-8333
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1666DT152WL0500X
TX6118TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89269Medicare UPIN
VA8A9396Medicare ID - Type Unspecified