Healthcare Provider Details

I. General information

NPI: 1235105461
Provider Name (Legal Business Name): SCOTT E WOODRUFF O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 NE GARDEN VALLEY BLVD
ROSEBURG OR
97470-2039
US

IV. Provider business mailing address

371 NE GARDEN VALLEY BLVD
ROSEBURG OR
97470-2039
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-4166
  • Fax: 541-673-0029
Mailing address:
  • Phone: 541-673-4166
  • Fax: 541-673-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1218AT
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: