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NPI Code Detail

MEDICARE: KRISTINA STASKO WOODWARD OD

MEDICARE: KRISTINA STASKO WOODWARD OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist8031TCA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21238570001OTHERCAMEDICARE SUPPLY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447231089
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA STASKO WOODWARD OD
Provider Business Mailing Address
First Line : 1234 CHERRY ST
Second Line :
City : SAN CARLOS
State : CA
Zip : 94070-3110
Country : US
Telephone Number : 560-593-1661
Fax Number : 650-595-5203
Provider Business Practice Location Address
First Line : 1234 CHERRY ST
Second Line :
City : SAN CARLOS
State : CA
Zip : 94070-3110
Country : US
Telephone Number : 560-593-1661
Fax Number : 650-595-5203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 07/08/2007

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Directions to “ KRISTINA STASKO WOODWARD OD” Practice Location

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