MEDICARE: DR. MARK R. WOLMER, P.C.

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	711	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588644033	OTHER	CT	PERSONAL NPI

General Provider Information

NPI Number	:	1639400112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MARK R. WOLMER, P.C.

Provider Business Mailing Address
First Line	:	62 NORTH ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5620
Country	:	US
Telephone Number	:	203-792-2020
Fax Number	:	203-792-9998

Provider Business Practice Location Address
First Line	:	62 NORTH ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5620
Country	:	US
Telephone Number	:	203-792-2020
Fax Number	:	203-792-9998

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK RICHARD WOLMER
Credential	:	O.D.
Telephone Number	:	203-792-2020

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	02/17/2010

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