MEDICARE: DR. STEPHANIE WOO OD

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	1812	AZ
2	152W00000X	Optometrist	2011019156	MO
3	152WC0802X	Corneal and Contact Management Optometrist	2011019156	MO

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

General Provider Information

NPI Number	:	1922396076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE WOO OD

Provider Business Mailing Address
First Line	:	383 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9368
Country	:	US
Telephone Number	:	928-680-1144
Fax Number	:	928-680-8639

Provider Business Practice Location Address
First Line	:	383 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9368
Country	:	US
Telephone Number	:	928-680-1144
Fax Number	:	928-680-8639

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

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	07/15/2020

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