Individual
MR. WILFRED JAMES FENNEWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
Contact information
Practice address
2737 NAVARRE AVE STE 204, OREGON, OH 43616-3276
(419) 693-3376
(419) 693-7519
Mailing address
2737 NAVARRE AVE STE 204, OREGON, OH 43616-3276
(419) 693-3376
(419) 693-7519
Taxonomy
Speciality
Code
Description
License number
State
156FC0801X
Contact Lens Fitter
SC2077
OH
156FX1800X
Optician
Primary
SC2077
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000155056
ANTHEM
OH
05
—
0511637
—
OH
01
—
10251
PARAMOUNT HEALTH CARE
OH
01
—
15295
SPECTERA
OH
01
—
31106091100
BWC
OH
01
—
311060911001
MEDICAL MUTUAL
OH
01
—
363492
NVA
OH
01
—
OH2077
EYEMED
OH
Enumeration date
12/14/2005
Last updated
01/28/2019
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