MEDICARE: DR. STEPHEN KING WHEELER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3006	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104832112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN KING WHEELER O.D.

Provider Business Mailing Address
First Line	:	322 N DETROIT ST
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-2233
Country	:	US
Telephone Number	:	937-376-4055
Fax Number	:	937-376-3969

Provider Business Practice Location Address
First Line	:	322 N DETROIT ST
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-2233
Country	:	US
Telephone Number	:	937-376-4055
Fax Number	:	937-376-3969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	11/27/2007

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