Provider Demographics
NPI:1174602791
Name:WOOL, DAVID D (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:WOOL
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 1:311 HEINEBERG DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6774
Mailing Address - Country:US
Mailing Address - Phone:802-658-6740
Mailing Address - Fax:802-863-2334
Practice Address - Street 1:311 HEINEBERG DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6774
Practice Address - Country:US
Practice Address - Phone:802-658-6740
Practice Address - Fax:802-863-2334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT 218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTT25385Medicare UPIN
VTVT6632Medicare ID - Type Unspecified
0473910001Medicare NSC