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General NPI Number Information
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NPI Number | 1851608186
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Entity Type | Organization
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Legal Business Name | WOODS VISION CARE SPECIALISTS, INC
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 100 E MAIN ST
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City | MASCOUTAH
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State | IL
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Zip | 62258-2135
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Country | US
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Telephone | 618-566-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E MAIN ST
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City | MASCOUTAH
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State | IL
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Zip | 62258-2135
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Country | US
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Telephone | 618-566-8899
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MARIANNE WANDA MCDANIEL
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Credential | O.D
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Telephone | 618-566-8899
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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 | 046008579
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046006501
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License Number State | IL
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