MEDICARE: ALETHEA LENORE WESSNER 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	OEG000477	PA

General Provider Information

NPI Number	:	1336275122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALETHEA LENORE WESSNER O.D.

Provider Business Mailing Address
First Line	:	231 S TULPEHOCKEN ST
Second Line	:
City	:	PINE GROVE
State	:	PA
Zip	:	17963-1037
Country	:	US
Telephone Number	:	570-345-6219
Fax Number	:	570-345-0267

Provider Business Practice Location Address
First Line	:	231 S TULPEHOCKEN ST
Second Line	:
City	:	PINE GROVE
State	:	PA
Zip	:	17963-1037
Country	:	US
Telephone Number	:	570-345-0188
Fax Number	:	570-345-0267

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/29/2008

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