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General NPI Number Information
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NPI Number | 1174108534
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Entity Type | Individual
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Provider Name | TODD ANDREW WEDEL OD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1130 S MICHIGAN AVE APT 2108
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City | CHICAGO
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State | IL
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Zip | 60605-2320
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Country | US
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Telephone | 972-979-4675
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Fax |
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Provider Business Mailing Address
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Address Line | 134 CENTRAL WAY
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City | KIRKLAND
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State | WA
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Zip | 98033-6106
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Country | US
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Telephone | 425-889-2020
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Fax | 425-739-0601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD61173002
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License Number State | WA
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