Healthcare Provider Details

I. General information

NPI: 1801993555
Provider Name (Legal Business Name): CARLA A WENDLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 MISSOURI AVE
LAS CRUCES NM
88001-5109
US

IV. Provider business mailing address

2448 MISSOURI AVE
LAS CRUCES NM
88001-5109
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-2020
  • Fax:
Mailing address:
  • Phone: 575-521-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2992
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number668
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: