Provider Demographics
NPI:1215962329
Name:WOOD VISION CLINIC INC
Entity type:Organization
Organization Name:WOOD VISION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-648-3306
Mailing Address - Street 1:322 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-2106
Mailing Address - Country:US
Mailing Address - Phone:641-648-3306
Mailing Address - Fax:641-648-2075
Practice Address - Street 1:322 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-2106
Practice Address - Country:US
Practice Address - Phone:641-648-3306
Practice Address - Fax:641-648-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18217Medicare PIN
IA5751220001Medicare NSC