=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194855841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA WESLEY WHEELER O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2150 NORTHWOODS BLVD UNIT E-2
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-4043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-572-5738
-----------------------------------------------------
Fax | 843-572-7282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 TRADD ST APT B
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29401-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-767-6756
-----------------------------------------------------
Fax | 843-572-7282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0872
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------