MEDICARE: ROBERT E WOODRUFF, II, OD, 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	3445T708	OH

General Provider Information

NPI Number	:	1851442818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT E WOODRUFF, II, OD, INC.

Provider Business Mailing Address
First Line	:	8051 VESTA AVE
Second Line	:	STE # 2
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2080
Country	:	US
Telephone Number	:	330-468-0585
Fax Number	:	330-468-1083

Provider Business Practice Location Address
First Line	:	8051 VESTA AVE
Second Line	:	STE # 2
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-2080
Country	:	US
Telephone Number	:	330-468-0585
Fax Number	:	330-468-1083

Authorized Official
Title or Position	:	PRESIDENT, OWNER
Name	:	DR. ROBERT WOODRUFF II
Credential	:	O.D.
Telephone Number	:	330-468-0585

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	06/16/2008

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