Healthcare Provider Details

I. General information

NPI: 1083887301
Provider Name (Legal Business Name): DR PAUL L WOOLF OPTOMETRIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 N HIGLEY RD STE 101
GILBERT AZ
85234-1614
US

IV. Provider business mailing address

1660 N HIGLEY RD STE 101
GILBERT AZ
85234-1614
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-1212
  • Fax: 480-830-0029
Mailing address:
  • Phone: 480-830-1212
  • Fax: 480-830-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number879
License Number StateAZ

VIII. Authorized Official

Name: DR. PAUL L WOOLF
Title or Position: PRESIDENT
Credential: O.D.
Phone: 480-830-1212