Provider Demographics
NPI:1265613749
Name:LAWRENCE A WOOD M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:LAWRENCE A WOOD M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-675-2020
Mailing Address - Street 1:10531 4S COMMONS DR
Mailing Address - Street 2:SUITE #168
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3517
Mailing Address - Country:US
Mailing Address - Phone:858-675-2020
Mailing Address - Fax:858-675-2036
Practice Address - Street 1:10531 4S COMMONS DR
Practice Address - Street 2:SUITE #168
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3517
Practice Address - Country:US
Practice Address - Phone:858-675-2020
Practice Address - Fax:858-675-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43071207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI35376Medicare UPIN