MEDICARE: DR. JOHN WILLIAM WOOD OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7093T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH492	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1033182829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILLIAM WOOD OD

Provider Business Mailing Address
First Line	:	252 W LOS ANGELES AVE
Second Line	:	SUITE G
City	:	MOORPARK
State	:	CA
Zip	:	93021-1888
Country	:	US
Telephone Number	:	805-529-5497
Fax Number	:	805-529-4987

Provider Business Practice Location Address
First Line	:	252 W LOS ANGELES AVE
Second Line	:	SUITE G
City	:	MOORPARK
State	:	CA
Zip	:	93021-1888
Country	:	US
Telephone Number	:	805-529-5497
Fax Number	:	805-529-4987

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	12/14/2015

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