Individual
DR. ROBERT EVERETT WOODRUFF II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8051 VESTA AVE, STE 2, NORTHFIELD, OH 44067-2044
(330) 468-0585
(330) 468-1083
Mailing address
PO BOX 207170 STE 2, DALLAS, TX 75320-7173
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3445T708
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000138931
ANTHEM ID
—
05
—
0403594
—
OH
01
—
061090001
DMERC/ADMINISTAR
—
01
—
341793205
FED ID NUMBER
—
01
—
580002428
PALMETTO MEDICARE NO.
—
Enumeration date
06/13/2005
Last updated
06/08/2021
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