Provider Demographics
NPI:1063855542
Name:DEPUTY, WESLEY T (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:T
Last Name:DEPUTY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 E WILLIAM ST STE 17
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4076
Mailing Address - Country:US
Mailing Address - Phone:775-297-4453
Mailing Address - Fax:775-841-2020
Practice Address - Street 1:444 E WILLIAM ST STE 17
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4076
Practice Address - Country:US
Practice Address - Phone:775-297-4453
Practice Address - Fax:775-841-2020
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV568156FX1800X, 156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter