Provider Demographics
NPI:1003868571
Name:HALLIER, WENDY SUE (OD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:HALLIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 MEADOWSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9240
Mailing Address - Country:US
Mailing Address - Phone:740-548-3635
Mailing Address - Fax:
Practice Address - Street 1:8084 E BROAD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8024
Practice Address - Country:US
Practice Address - Phone:614-864-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2178647Medicaid
OHHA4108824Medicare ID - Type Unspecified
OHU43370Medicare UPIN
OH2178647Medicaid