MEDICARE: JUDITH A WENTZEL

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
1	156FX1800X	Optician		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14872	OTHER	SPECTERA
3	49647	OTHER	DAVIS VISION

General Provider Information

NPI Number	:	1679661771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH A WENTZEL

Provider Business Mailing Address
First Line	:	120 MAIN STREET PO BOX 430
Second Line	:
City	:	NEW EAGLE
State	:	PA
Zip	:	15067
Country	:	US
Telephone Number	:	724-258-3773
Fax Number	:	724-258-4805

Provider Business Practice Location Address
First Line	:	120 MAIN STREET
Second Line	:
City	:	NEW EAGLE
State	:	PA
Zip	:	15067
Country	:	US
Telephone Number	:	724-258-3773
Fax Number	:	724-258-4805

Authorized Official
Title or Position	:	OPTICIAN OWNER
Name	:	MRS. JUDITH A ZEWE
Credential	:	OPTICIAN
Telephone Number	:	724-258-3773

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	06/17/2008

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Directions to “JUDITH A WENTZEL ” Practice Location

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