Healthcare Provider Details

I. General information

NPI: 1902006083
Provider Name (Legal Business Name): FREDERICK A. WOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 THE COMMONS
ITHACA NY
14850-5542
US

IV. Provider business mailing address

134 THE COMMONS
ITHACA NY
14850-5542
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-4231
  • Fax: 607-273-4654
Mailing address:
  • Phone: 607-273-4231
  • Fax: 607-273-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV 3413
License Number StateNY

VIII. Authorized Official

Name: DR. FREDERICK A. WOOD
Title or Position: OPTOMETRIST / OWNER
Credential: O.D.
Phone: 607-273-4231