Provider Demographics
NPI:1013186485
Name:RHONDA A WENDEKIER
Entity Type:Organization
Organization Name:RHONDA A WENDEKIER
Other - Org Name:CARROLLTOWN FAMILY VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WENDEKIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-344-2005
Mailing Address - Street 1:2056 PLANK ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-0243
Mailing Address - Country:US
Mailing Address - Phone:814-344-2005
Mailing Address - Fax:814-344-8197
Practice Address - Street 1:2056 PLANK ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722-0243
Practice Address - Country:US
Practice Address - Phone:814-344-2005
Practice Address - Fax:814-344-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001650332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU76783Medicare UPIN
PA5376780001Medicare NSC
PA031188Medicare PIN