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NPI Code Detail

MEDICARE: HENRY E WOODCOME OD

MEDICARE: HENRY E WOODCOME 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
1152W00000XOptometrist2607MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100026097302OTHERNYUNIVERA # LTH
2101944CSOTHERNYPREFERRED CARE # LTH
3P010003495OTHERNYBLUE CHOICE # LTH

General Provider Information

NPI Number : 1861450181
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY E WOODCOME OD
Provider Business Mailing Address
First Line : 63 MAIN ST
Second Line : ATTN: VIRGILIA PIRES
City : BROCKTON
State : MA
Zip : 02301-4042
Country : US
Telephone Number : 508-894-3503
Fax Number : 508-559-5073
Provider Business Practice Location Address
First Line : 63 MAIN ST
Second Line : BROCKTON NEIGHBORHOOD HEALTH CENTER
City : BROCKTON
State : MA
Zip : 02301-4042
Country : US
Telephone Number : 508-894-3503
Fax Number : 508-559-5073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 10/12/2016

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