Provider Demographics
NPI:1841339934
Name:WOOD, CLIFFORD L (OD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:L
Last Name:WOOD
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 1:408 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-2731
Mailing Address - Country:US
Mailing Address - Phone:850-547-3402
Mailing Address - Fax:850-547-4113
Practice Address - Street 1:408 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2731
Practice Address - Country:US
Practice Address - Phone:850-547-3402
Practice Address - Fax:850-547-4113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620867300Medicaid
FL19796OtherBLUE CROSS BLUE SHIELD
FL19796Medicare ID - Type Unspecified
FL0845940002Medicare NSC
FL19796OtherBLUE CROSS BLUE SHIELD