Organization
RICHARD WIENER, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WIENER O.D. (OWNER)
(765) 825-4127
Entity
Organization
Contact information
Practice address
124 E 6TH ST, CONNERSVILLE, IN 47331-2025
(765) 825-4127
(765) 827-6577
Mailing address
124 E 6TH ST, CONNERSVILLE, IN 47331-2025
(765) 825-4127
(765) 827-6577
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114620A
—
IN
01
—
4299980001
DMEPOS NUMBER
IN
Enumeration date
11/24/2008
Last updated
11/24/2008
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