MEDICARE: DR. MARK V WEDUL MD

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	207W00000X	Ophthalmology Physician	29010	MN

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

General Provider Information

NPI Number	:	1346294295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK V WEDUL MD

Provider Business Mailing Address
First Line	:	1570 CONCORDIA AVE STE 202
Second Line	:	LEXINGTON EYE ASSOCIATES PA
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5345
Country	:	US
Telephone Number	:	651-646-7419
Fax Number	:	651-637-2778

Provider Business Practice Location Address
First Line	:	1570 CONCORDIA AVE STE 202
Second Line	:	LEXINGTON EYE ASSOCIATES PA
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5345
Country	:	US
Telephone Number	:	651-646-7419
Fax Number	:	651-646-7419

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	04/07/2015

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