Individual provider Active NPI

William R Woodman, O.D.

  • Optometrist
  • Bend, OR
National Provider Identifier
1619024916
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2164ATI Issued in OR
Practice address
1900 NE 3Rd St Ste 102
Bend, OR 97701-3854
Phone
(541) 385-5848
Fax
(541) 330-0988
NPI assigned
Jan 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2164ATI OR Primary

Addresses

Primary practice location

1900 NE 3Rd St Ste 102
Bend, OR 97701-3854

Mailing address

1900 NE 3Rd St Ste 102
Bend, OR 97701-3854
Phone (541) 385-5848

Other identifiers 1

IdentifierTypeStateIssuer
023270MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050718000578 OR Practitioner - Optometry 9032104666 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2164ORMDPsychologist
2164ATIORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
RFH Optometric, LLC Optometrist CurrentSince Sep 1, 2018 Accepting new patients
William R Woodman OD PC Optometrist Past Accepting new patients

Locations

1250 NE 3rd St
Ste B100
Bend, OR 97701
Phone (541) 317-1700

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1619024916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 NE 3RD ST STE 102",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013854",
            "telephone_number": "541-385-5848",
            "fax_number": "541-330-0988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 NE 3RD ST STE 102",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013854",
            "telephone_number": "541-385-5848",
            "fax_number": "541-330-0988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODMAN",
        "first_name": "WILLIAM",
        "middle_name": "R",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2164ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023270",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.