Provider Demographics
NPI:1215050059
Name:JOHN E WOOD INC.
Entity type:Organization
Organization Name:JOHN E WOOD INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LENARD
Authorized Official - Last Name:GANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-949-5182
Mailing Address - Street 1:10400 CONNECTICUT AVE
Mailing Address - Street 2:#101
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3910
Mailing Address - Country:US
Mailing Address - Phone:301-949-5182
Mailing Address - Fax:301-949-4888
Practice Address - Street 1:10400 CONNECTICUT AVE
Practice Address - Street 2:#101
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3910
Practice Address - Country:US
Practice Address - Phone:301-949-5182
Practice Address - Fax:310-949-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0445590001Medicare ID - Type Unspecified