Provider Demographics
NPI:1972591105
Name:WOOD, RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 E BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6141
Mailing Address - Country:US
Mailing Address - Phone:480-570-5318
Mailing Address - Fax:480-726-2446
Practice Address - Street 1:1496 N HIGLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1601
Practice Address - Country:US
Practice Address - Phone:480-279-4400
Practice Address - Fax:480-981-0548
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ079582Medicaid
AZ76999Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBER
AZU97500Medicare UPIN
AZ109141Medicare ID - Type Unspecified