MEDICARE: BERNADETTE SUSAN WOODS-MCSHANE INC

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 2573	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5886500001	OTHER	FL	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AG499	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1831392323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNADETTE SUSAN WOODS-MCSHANE INC

Provider Business Mailing Address
First Line	:	4310 S HOPKINS AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-6610
Country	:	US
Telephone Number	:	321-383-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 S HOPKINS AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-6610
Country	:	US
Telephone Number	:	321-383-7772
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUSAN BERNADETTE WOODS
Credential	:	O.D
Telephone Number	:	321-383-7772

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	01/14/2009

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