Basic Information
| Provider Information | |||||||||
| NPI: | 1962060863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | MITCHELL | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5120 NE 4TH ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344701568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528120250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1433 E LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323014747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508774687 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5659 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.