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General NPI Number Information
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NPI Number | 1902511900
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Entity Type | Organization
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Legal Business Name | CASSANDRA WOOD, O.D., LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 2214 FAYETTEVILLE RD
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City | VAN BUREN
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State | AR
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Zip | 72956-6508
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Country | US
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Telephone | 479-279-0454
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Fax |
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Provider Business Mailing Address
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Address Line | 2214 FAYETTEVILLE RD
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City | VAN BUREN
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State | AR
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Zip | 72956-6508
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Country | US
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Telephone | 479-279-0454
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Fax | 479-777-9841
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | CASSANDRA WOOD
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Credential | OD
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Telephone | 479-279-0454
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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 |
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License Number State |
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