MEDICARE: CLIFFORD L. WOOD O.D. P.A.

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	OPC 1706	FL

General Provider Information

NPI Number	:	1437402732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD L. WOOD O.D. P.A.

Provider Business Mailing Address
First Line	:	408 E HIGHWAY 90
Second Line	:
City	:	BONIFAY
State	:	FL
Zip	:	32425-2731
Country	:	US
Telephone Number	:	850-547-3402
Fax Number	:	850-547-4113

Provider Business Practice Location Address
First Line	:	408 E HIGHWAY 90
Second Line	:
City	:	BONIFAY
State	:	FL
Zip	:	32425-2731
Country	:	US
Telephone Number	:	850-547-3402
Fax Number	:	850-547-4113

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLIFFORD LEE WOOD I
Credential	:	O.D.
Telephone Number	:	850-547-3402

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	11/14/2012

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