Active NPI
Keith A Woodard, O.D.
- Optometrist
- Bryan, OH
National Provider Identifier
1124027982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3154/T707
- Practice address
- 1313 W High St
Bryan, OH 43506-1545 - Phone
- (419) 636-1531
- Fax
- (419) 636-1025
- NPI assigned
- Jul 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3154/T707 | OH | Primary |
Addresses
Primary practice location
1313 W High St
Bryan, OH 43506-1545
Mailing address
1313 W High St
Bryan, OH 43506-1545
Phone (419) 636-1531
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2740583 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3154/T707 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205366400000",
"number": "1124027982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1313 W HIGH ST",
"city": "BRYAN",
"state": "OH",
"postal_code": "435061545",
"telephone_number": "419-636-1531",
"fax_number": "419-636-1025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 W HIGH ST",
"city": "BRYAN",
"state": "OH",
"postal_code": "435061545",
"telephone_number": "419-636-1531",
"fax_number": "419-636-1025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODARD",
"first_name": "KEITH",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-14",
"last_updated": "2008-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3154/T707",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2740583",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bryan, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.