MEDICARE: WOOLF EYE CLINIC, LTD

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	174400000X	Specialist	12396	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CS0717	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AZ0029640	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1811189731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOLF EYE CLINIC, LTD

Provider Business Mailing Address
First Line	:	PO BOX 31447
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85275-1447
Country	:	US
Telephone Number	:	480-969-1000
Fax Number	:	480-644-0869

Provider Business Practice Location Address
First Line	:	2855 E BROWN RD
Second Line	:	SUITE #10
City	:	MESA
State	:	AZ
Zip	:	85213-4213
Country	:	US
Telephone Number	:	480-969-1000
Fax Number	:	480-644-0869

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM A WOOLF
Credential	:	M.D.
Telephone Number	:	480-969-1000

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	07/08/2010

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Directions to “WOOLF EYE CLINIC, LTD ” Practice Location

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