Individual
DR. THOMAS WHALEN WOODWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
304 E MAIN ST, EMMETT, ID 83617-3034
(208) 365-4531
Mailing address
304 E MAIN ST, PO BOX 687, EMMETT, ID 83617-3034
(208) 365-4531
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-0557
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002451000
—
ID
05
—
807303600
—
ID
Enumeration date
10/11/2006
Last updated
06/08/2009
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