Individual
MR. WILFRED JAMES FENNEWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
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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