Provider Demographics
NPI:1720168289
Name:WOODARD, D REID (OD)
Entity Type:Individual
Prefix:DR
First Name:D
Middle Name:REID
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-1090
Mailing Address - Country:US
Mailing Address - Phone:336-227-4448
Mailing Address - Fax:336-226-3926
Practice Address - Street 1:304 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3320
Practice Address - Country:US
Practice Address - Phone:336-227-4448
Practice Address - Fax:336-226-3926
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09081OtherBCBS
NC8909081Medicaid
14236OtherPARTNERS
2200608OtherUNITED HEALTH CARE
NC246517Medicare PIN
NC0434140001Medicare NSC