Healthcare Provider Details

I. General information

NPI: 1275519258
Provider Name (Legal Business Name): JUSTIN C WEHR OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 SOUTHGATE PKWY
CAMBRIDGE OH
43725-2944
US

IV. Provider business mailing address

1225 SOUTHGATE PKWY
CAMBRIDGE OH
43725-2944
US

V. Phone/Fax

Practice location:
  • Phone: 740-432-3384
  • Fax: 740-439-0101
Mailing address:
  • Phone: 740-432-3384
  • Fax: 740-439-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberS.6562
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT1957
License Number StateOH

VIII. Authorized Official

Name: DR. JUSTIN C WEHR
Title or Position: CO OWNER
Credential: OD
Phone: 740-432-3384