Individual
DR. MARK EDWARD WIEDENFELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
905 S JOHN REDDITT DR, LUFKIN, TX 75904-4326
(936) 634-4913
(936) 637-7811
Mailing address
905 S JOHN REDDITT DR, LUFKIN, TX 75904-4326
(936) 634-4913
(936) 637-7811
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5167TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003FB
BLUE CROSS BLUE SHIELD
TX
05
—
0191736-01
—
TX
Enumeration date
07/21/2006
Last updated
07/08/2007
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