Individual
THEODORE M WANDZILAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1348 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1307
(502) 634-8100
(502) 637-6396
Mailing address
1348 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1307
(502) 634-8100
(502) 637-6396
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
22152
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64221526
—
KY
Enumeration date
08/18/2005
Last updated
01/09/2008
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