Healthcare Provider Details

I. General information

NPI: 1992950547
Provider Name (Legal Business Name): RICHARD WIENER, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E 6TH ST
CONNERSVILLE IN
47331-2025
US

IV. Provider business mailing address

124 E 6TH ST
CONNERSVILLE IN
47331-2025
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-4127
  • Fax: 765-827-6577
Mailing address:
  • Phone: 765-825-4127
  • Fax: 765-827-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD WIENER
Title or Position: OWNER
Credential: O.D.
Phone: 765-825-4127