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NPI Code Detail

MEDICARE: DR. AUTUMNN EUNIQUE WOOTEN OD

MEDICARE: DR. AUTUMNN EUNIQUE WOOTEN 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
1152W00000XOptometrist10343TTX
2152W00000XOptometrist10343TGTX

General Provider Information

NPI Number : 1053988550
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUTUMNN EUNIQUE WOOTEN OD
Provider Business Mailing Address
First Line : 1950 OLD GALLOWS RD STE 520
Second Line :
City : VIENNA
State : VA
Zip : 22182-3970
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 11159 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77042-3218
Country : US
Telephone Number : 713-978-7504
Fax Number : 713-266-5828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2021
Last Update Date : 02/24/2022

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