MEDICARE: MR. SAMUEL C WEN 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
1	152W00000X	Optometrist	7705T	TX

General Provider Information

NPI Number	:	1871871905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL C WEN O.D.

Provider Business Mailing Address
First Line	:	4703 APPLE ROCK CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3069
Country	:	US
Telephone Number	:	832-971-8910
Fax Number	:

Provider Business Practice Location Address
First Line	:	4703 APPLE ROCK CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3069
Country	:	US
Telephone Number	:	832-971-8910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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