Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D-1143 | NJ |
NPI | 1043513443 |
---|---|
Provider Name | William James Wood |
First Address | Fort Collins, CO 80525-2821 |
Second Address | Fort Collins, CO 80525-2821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2010 |
Last Update Date | 07/12/2010 |