1376568618 NPI number — DR. DAWN WOODS O.D.

Table of content: DR. DAWN WOODS O.D. (NPI 1376568618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376568618 NPI number — DR. DAWN WOODS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
DAWN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376568618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 HOLLISTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93111-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-692-6977
Provider Business Mailing Address Fax Number:
805-692-6987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 HOLLISTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93111-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-692-6977
Provider Business Practice Location Address Fax Number:
805-692-6987
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  07390T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40937 . This is a "DAVIS VISION ID #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA7390 . This is a "EYEMED ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 07390T . This is a "OPT LISC #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 77-0049461 . This is a "OLD TAX ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: SD0073900 . This is a "BLUESHEILD ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 59-3792228 . This is a "CURRENT TAX ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6608 . This is a "MEDICAL EYE SERVICES ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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