Individual
DR. RICHARD WIENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O,D.
Contact information
Practice address
124 E 6TH ST, CONNERSVILLE, IN 47331-2025
(765) 825-4127
(765) 827-6577
Mailing address
PO BOX 427, CONNERSVILLE, IN 47331-0427
(765) 825-4127
(765) 827-6577
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
IN1652
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114620A
—
IN
01
—
260070A
MEDICARE-UNSPECIFIED PTAN
IN
Enumeration date
11/17/2006
Last updated
06/12/2009
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