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NPI Code Detail

MEDICARE: DR. DAVID M WENZ O.D.

MEDICARE: DR. DAVID M WENZ O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist27TO00110700NJ
2152W00000XOptometrist3283TOR
3152W00000XOptometrist2613NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00318029OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12K5747OTHERHEALTHNET
27312177OTHERAETNA
408-02549OTHEREVERCARE
5C406C10OTHEREMPIRE

General Provider Information

NPI Number : 1467531590
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID M WENZ O.D.
Provider Business Mailing Address
First Line : 11086 S.E. OAK ST.
Second Line :
City : MILWAUKEE
State : OR
Zip : 97222-6692
Country : US
Telephone Number : 503-557-2020
Fax Number : 503-344-5110
Provider Business Practice Location Address
First Line : 3901 OLEANDER DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6733
Country : US
Telephone Number : 910-395-2772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 05/15/2020

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