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General NPI Number Information
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NPI Number | 1487793667
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Entity Type | Organization
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Legal Business Name | GREG WOODWORTH OD INC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 575 FLETCHER PKWY
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City | EL CAJON
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State | CA
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Zip | 92020-2522
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Country | US
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Telephone | 619-447-5555
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Fax | 619-447-5089
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Provider Business Mailing Address
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Address Line | 575 FLETCHER PKWY
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City | EL CAJON
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State | CA
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Zip | 92020-2522
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Country | US
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Telephone | 619-447-5555
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Fax | 619-447-5089
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. GREG K WOODWORTH
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Credential | OD
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Telephone | 619-447-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number | 7606TPA
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | 7606TPA
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 7606TPA
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7606TPA
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License Number State | CA
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