=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932899135
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN VERNETTE WOOD DO 60207182
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2023
-----------------------------------------------------
Last Update Date | 05/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10428 185TH AVE SW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98579-9384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-789-4032
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10428 185TH AVE SW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98579-9384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-789-4032
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | DO60207182
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------