Provider Demographics
NPI:1538274899
Name:WOOD, ANITA J (OD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:J
Last Name:WOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1109 E 3RD ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2285
Mailing Address - Country:US
Mailing Address - Phone:618-622-1684
Mailing Address - Fax:
Practice Address - Street 1:6570 N ILLINOIS ST STE A
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2195
Practice Address - Country:US
Practice Address - Phone:618-628-3502
Practice Address - Fax:618-628-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist