Provider Demographics
NPI:1912089111
Name:WOOD, FREDERICK A (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
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 1:134 THE COMMONS
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5542
Mailing Address - Country:US
Mailing Address - Phone:607-273-4231
Mailing Address - Fax:607-273-4654
Practice Address - Street 1:134 THE COMMONS
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5542
Practice Address - Country:US
Practice Address - Phone:607-273-4231
Practice Address - Fax:607-273-4654
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT 3413152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39832BMedicare PIN
NYT26633Medicare UPIN
NY39832AMedicare PIN
NY0128860001Medicare NSC