Healthcare Provider Details

I. General information

NPI: 1700966355
Provider Name (Legal Business Name): MARY BETH BETH WOEHRLE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 S AVERITT ROAD SUITE 4
GREENWOOD IN
46143-9450
US

IV. Provider business mailing address

9795 CROSSPOINT BLVD SUITE 100
INDIANAPOLIS IN
46256-3354
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-4143
  • Fax: 317-259-8609
Mailing address:
  • Phone: 317-254-6480
  • Fax: 317-259-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number8002492B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002492A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: