Provider Demographics
NPI:1649263815
Name:WOODARD, STEVEN C (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:WOODARD
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 1:106 MANZANARES AVE E
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4213
Mailing Address - Country:US
Mailing Address - Phone:505-835-2020
Mailing Address - Fax:505-835-9165
Practice Address - Street 1:106 MANZANARES AVE E
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4213
Practice Address - Country:US
Practice Address - Phone:505-835-2020
Practice Address - Fax:505-835-9165
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2590996Medicare ID - Type Unspecified
NMT74962Medicare UPIN