Healthcare Provider Details

I. General information

NPI: 1942252820
Provider Name (Legal Business Name): JENNIFER D WOOD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 RIVERY BLVD STE 2005
GEORGETOWN TX
78628-3064
US

IV. Provider business mailing address

1500 RIVERY BLVD STE 2005
GEORGETOWN TX
78628-3064
US

V. Phone/Fax

Practice location:
  • Phone: 512-686-3424
  • Fax: 737-253-8333
Mailing address:
  • Phone: 512-686-3424
  • Fax: 737-253-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1666DT
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6118TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: