Provider Demographics
NPI:1093986234
Name:DR. STEVEN P. WETCHER, OPTOMETRIC PHYSICIAN
Entity Type:Organization
Organization Name:DR. STEVEN P. WETCHER, OPTOMETRIC PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-822-8199
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:GREEN VILLAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07935-0283
Mailing Address - Country:US
Mailing Address - Phone:973-822-8199
Mailing Address - Fax:973-660-0420
Practice Address - Street 1:268 GREEN VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GREEN VILLAGE
Practice Address - State:NJ
Practice Address - Zip Code:07935-3027
Practice Address - Country:US
Practice Address - Phone:973-822-8199
Practice Address - Fax:973-660-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00377500332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0366420001Medicare NSC
T81525Medicare UPIN