Provider Demographics
NPI:1063525681
Name:WOOD, ROSE NAVIN (OD)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:NAVIN
Last Name:WOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EASTERN BLVD N
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5978
Mailing Address - Country:US
Mailing Address - Phone:240-420-8888
Mailing Address - Fax:240-420-8400
Practice Address - Street 1:101 EASTERN BLVD N
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5978
Practice Address - Country:US
Practice Address - Phone:240-420-8888
Practice Address - Fax:240-420-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410046764OtherRAILROAD MEDICARE
135M069FMedicare PIN
410046764OtherRAILROAD MEDICARE