Provider Demographics
NPI:1023423787
Name:WOODALL EYE CARE, P.C.
Entity type:Organization
Organization Name:WOODALL EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-797-1570
Mailing Address - Street 1:479 CREEKWOOD DR
Mailing Address - Street 2:UNIT #158
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9276
Mailing Address - Country:US
Mailing Address - Phone:812-797-1570
Mailing Address - Fax:
Practice Address - Street 1:479 CREEKWOOD DR
Practice Address - Street 2:UNIT #158
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9276
Practice Address - Country:US
Practice Address - Phone:812-797-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003788A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty