=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689734543
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MABLE WOO O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3120 E UNION HILLS DR SUITE 105
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-3421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-867-4200
-----------------------------------------------------
Fax | 602-867-4450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3120 E UNION HILLS DR SUITE 105
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-3421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-867-4200
-----------------------------------------------------
Fax | 602-867-4450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1145
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------