Healthcare Provider Details

I. General information

NPI: 1215962329
Provider Name (Legal Business Name): WOOD VISION CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 COLLEGE AVE
IOWA FALLS IA
50126-2106
US

IV. Provider business mailing address

322 COLLEGE AVE
IOWA FALLS IA
50126-2106
US

V. Phone/Fax

Practice location:
  • Phone: 641-648-3306
  • Fax: 641-648-2075
Mailing address:
  • Phone: 641-648-3306
  • Fax: 641-648-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AMANDA A WOOD
Title or Position: VICE PRESIDENT
Credential: O.D.
Phone: 641-648-3306