Provider Demographics
NPI:1548376098
Name:WOOD, CARLETON J (OD)
Entity type:Individual
Prefix:MR
First Name:CARLETON
Middle Name:J
Last Name:WOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1630
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508
Mailing Address - Country:US
Mailing Address - Phone:304-855-3535
Mailing Address - Fax:304-855-3535
Practice Address - Street 1:101 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-3535
Practice Address - Fax:304-855-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7420152W00000X
WV742-0152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150711000Medicaid
WV000537408OtherBC BS
WV410001206OtherRAILROAD MEDICARE
WV0150711000Medicaid
T32581Medicare UPIN
WV9186881Medicare PIN