Provider Demographics
NPI:1821415241
Name:WOOD, WESTLEY THOMAS (OWNER)
Entity type:Individual
Prefix:MR
First Name:WESTLEY
Middle Name:THOMAS
Last Name:WOOD
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3005
Mailing Address - Country:US
Mailing Address - Phone:810-720-1300
Mailing Address - Fax:810-720-1318
Practice Address - Street 1:3249 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3005
Practice Address - Country:US
Practice Address - Phone:810-720-1300
Practice Address - Fax:810-720-1318
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI61-1559792156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician