Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | MS495 | MS |
NPI | 1013030964 |
---|---|
Provider Name | Dr. William Terry Wood |
First Address | Pontotoc, MS 38863-2822 |
Second Address | Pontotoc, MS 38863-2811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 28/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00087916 | (05) | MS |
0652140001 | CIGNA GOVERNMENT (01) | MS |
T20905 | (02) | MS |