Healthcare Provider Details

I. General information

NPI: 1619042918
Provider Name (Legal Business Name): CHRISTOPHER EDWIN WOODRUFF O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR NSU THE EYE INSTITUTE SUITE 1402
DAVIE FL
33328-2018
US

IV. Provider business mailing address

1683 ISLAND WAY
WESTON FL
33326-3625
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1402
  • Fax: 954-262-1818
Mailing address:
  • Phone: 954-384-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC2782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: