Provider Demographics
NPI:1962461582
Name:WOOD, NETA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:NETA
Middle Name:LEE
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 1:800 PROFESSIONAL ACRES BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4340
Mailing Address - Country:US
Mailing Address - Phone:870-972-5540
Mailing Address - Fax:870-972-5684
Practice Address - Street 1:800 PROFESSIONAL ACRES BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-972-5540
Practice Address - Fax:870-972-5684
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47825OtherBCBS ARK
AR5C186OtherBCBS
AR101747722Medicaid
T86123Medicare UPIN
42825Medicare ID - Type Unspecified