MEDICARE: DR. ALETHEA WESSNER LLC

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	OEG000477	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1881966265	OTHER	PA	NPI

General Provider Information

NPI Number	:	1881966265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ALETHEA WESSNER LLC

Provider Business Mailing Address
First Line	:	231 S TULPEHOCKEN ST
Second Line	:
City	:	PINE GROVE
State	:	PA
Zip	:	17963-1037
Country	:	US
Telephone Number	:	570-345-0188
Fax Number	:	570-345-0267

Provider Business Practice Location Address
First Line	:	231 S TULPEHOCKEN ST
Second Line	:
City	:	PINE GROVE
State	:	PA
Zip	:	17963-1037
Country	:	US
Telephone Number	:	570-345-0188
Fax Number	:	570-345-0267

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. ALETHEA WESSNER
Credential	:	D.O.
Telephone Number	:	570-345-0188

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/04/2013

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