Provider Demographics
NPI:1043754781
Name:PAUL J.WESLING, O.D., INC.
Entity Type:Organization
Organization Name:PAUL J.WESLING, O.D., INC.
Other - Org Name:LEMON GROVE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-697-2020
Mailing Address - Street 1:7850 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7850 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1801
Practice Address - Country:US
Practice Address - Phone:619-697-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL J. WESLING, O.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10869TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT10869Medicare PIN