Provider Demographics
NPI:1932899135
Name:WOOD, LYNN VERNETTE (DO 60207182)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:VERNETTE
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO 60207182
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10428 185TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-9384
Mailing Address - Country:US
Mailing Address - Phone:360-789-4032
Mailing Address - Fax:
Practice Address - Street 1:10428 185TH AVE SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-9384
Practice Address - Country:US
Practice Address - Phone:360-789-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60207182156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician