Provider Demographics
NPI:1952383457
Name:WOOD, CHERYL C
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:C
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:IN
Mailing Address - Zip Code:47446-1410
Mailing Address - Country:US
Mailing Address - Phone:812-849-4385
Mailing Address - Fax:812-849-0078
Practice Address - Street 1:527 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:IN
Practice Address - Zip Code:47446-1410
Practice Address - Country:US
Practice Address - Phone:812-849-4385
Practice Address - Fax:812-849-0078
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0217520001Medicare ID - Type Unspecified