=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124284773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM D. WOODS, OD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2008
-----------------------------------------------------
Last Update Date | 10/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1498 MERCHANTS DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30132-5064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-445-2715
-----------------------------------------------------
Fax | 770-445-5805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1498 MERCHANTS DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30132-5064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-445-2715
-----------------------------------------------------
Fax | 770-445-5805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER/WIFE
-----------------------------------------------------
Name | JANIS WOODS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-445-2715
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 871GA
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------