Individual
THOMAS JOSEPH WIEGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
712 CAMERON WOODS DR, ANGOLA, IN 46703
(260) 668-3937
(260) 668-3794
Mailing address
PO BOX 549, WABASH, IN 46992-0549
(260) 569-9550
(260) 569-0760
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001620
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092387
ANTHEM BCBS
IN
05
—
100152890
—
IN
Enumeration date
05/31/2005
Last updated
08/15/2018
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