Healthcare Provider Details

I. General information

NPI: 1932125424
Provider Name (Legal Business Name): CRAIG H WOOD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W FRIENDLY AVE SUITE 200
GREENSBORO NC
27410-4368
US

IV. Provider business mailing address

5500 W FRIENDLY AVE SUITE 200
GREENSBORO NC
27410-4368
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-4516
  • Fax: 336-292-5706
Mailing address:
  • Phone: 336-292-4516
  • Fax: 336-292-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1695
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001193
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: