MEDICARE: DR. ROBERT EVERETT WOODRUFF II O.D.

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	3445T708	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	580002428	OTHER		PALMETTO MEDICARE NO.

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000138931	OTHER	ANTHEM ID
2	341793205	OTHER	FED ID NUMBER
3	061090001	OTHER	DMERC/ADMINISTAR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194729533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EVERETT WOODRUFF II O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207170 STE 2
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7173
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	8051 VESTA AVE
Second Line	:	STE 2
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2044
Country	:	US
Telephone Number	:	330-468-0585
Fax Number	:	330-468-1083

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/08/2021

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Directions to “ DR. ROBERT EVERETT WOODRUFF II O.D.” Practice Location

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