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General NPI Number Information
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NPI Number | 1831392323
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Entity Type | Organization
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Legal Business Name | BERNADETTE SUSAN WOODS-MCSHANE INC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 4310 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-6610
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Country | US
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Telephone | 321-383-7772
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-6610
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Country | US
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Telephone | 321-383-7772
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN BERNADETTE WOODS
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Credential | O.D
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Telephone | 321-383-7772
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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 | OPC 2573
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License Number State | FL
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