Healthcare Provider Details

I. General information

NPI: 1972591105
Provider Name (Legal Business Name): RICHARD WOOD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 N HIGLEY RD SUITE 104
GILBERT AZ
85234-1601
US

IV. Provider business mailing address

1378 E BOSTON ST
GILBERT AZ
85296-6141
US

V. Phone/Fax

Practice location:
  • Phone: 480-279-4400
  • Fax: 480-981-0548
Mailing address:
  • Phone: 480-570-5318
  • Fax: 480-726-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1148
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: