Provider Demographics
NPI:1952453813
Name:WOOD, GEORGE STEPHEN (O D)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:STEPHEN
Last Name:WOOD
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WEST MAIN ST
Mailing Address - Street 2:PO BOX 100
Mailing Address - City:POWDERLY
Mailing Address - State:KY
Mailing Address - Zip Code:42367-0100
Mailing Address - Country:US
Mailing Address - Phone:270-338-4091
Mailing Address - Fax:270-338-7913
Practice Address - Street 1:609 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-0100
Practice Address - Country:US
Practice Address - Phone:270-338-4091
Practice Address - Fax:270-338-7913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1033 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0005070459OtherAETNA
KY24916OtherAVESIS
KYC 9226901OtherUNITED AMERICAN
KY000000218896OtherANTHEM BC-BS OF KY
KYKY 1033OtherEYEMED
KY379358OtherCOMBINED INS. CO. OF AMER
KY77010338Medicaid
KYKY01944861OtherFUNDS
KYXXXX7992 42367 0000OtherTRICARE
KY051905000073OtherHEALTHSCOPE
KY96600OtherSPECTERA
KYC 9226901OtherUNITED AMERICAN
KY24916OtherAVESIS
0407660001Medicare NSC