Healthcare Provider Details

I. General information

NPI: 1508885245
Provider Name (Legal Business Name): THURMAN E WOOD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4819 CALLOWAY DR STE 101
BAKERSFIELD CA
93312-5691
US

IV. Provider business mailing address

4819 CALLOWAY DR STE 101
BAKERSFIELD CA
93312-5691
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-7739
  • Fax: 661-325-2731
Mailing address:
  • Phone: 661-325-7739
  • Fax: 661-325-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9498T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number9498T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number9498T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number9498T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: