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General NPI Number Information
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NPI Number | 1356513568
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Entity Type | Organization
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Legal Business Name | WILLIAM R WOODMAN OD PC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 492 E MAIN AVE
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City | SISTERS
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State | OR
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Zip | 97759-1329
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Country | US
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Telephone | 541-549-2851
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Fax | 541-549-4473
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | SISTERS
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State | OR
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Zip | 97759-1329
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Country | US
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Telephone | 541-549-2851
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Fax | 541-549-4473
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM R WOODMAN
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Credential | O.D.
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Telephone | 541-549-2851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2164ATI
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License Number State | OR
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