Individual
ETHAN DAVID WOHLGEMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1001 N GRAND AVE, TAHLEQUAH, OK 74464-7017
(918) 444-4031
Mailing address
1001 N GRAND AVE, TAHLEQUAH, OK 74464-7017
(918) 444-4031
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3249
OK
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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