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NPI Code Detail

MEDICARE: MR. ALEX MICHAEL WAHL O.D.

MEDICARE:  MR. ALEX MICHAEL WAHL  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
1152W00000XOptometrist1971NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3DA3706OTHERNCMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2093RPOTHERNCBCBS

General Provider Information

NPI Number : 1710085188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALEX MICHAEL WAHL O.D.
Provider Business Mailing Address
First Line : 515 N SPENCE AVE
Second Line :
City : GOLDSBORO
State : NC
Zip : 27534-4261
Country : US
Telephone Number : 919-778-7110
Fax Number : 919-778-6057
Provider Business Practice Location Address
First Line : 515 N SPENCE AVE
Second Line :
City : GOLDSBORO
State : NC
Zip : 27534-4261
Country : US
Telephone Number : 919-778-7110
Fax Number : 919-778-6057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 06/30/2010

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Directions to “ MR. ALEX MICHAEL WAHL O.D.” Practice Location

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