Provider Demographics
NPI:1134114382
Name:WIELAND, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:WIELAND
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2485 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4101
Mailing Address - Country:US
Mailing Address - Phone:650-988-7480
Mailing Address - Fax:650-988-7482
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-988-7480
Practice Address - Fax:650-988-7482
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-12-14
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Provider Licenses
StateLicense IDTaxonomies
CA00A48482207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A484821Medicaid
CABX907YMedicare PIN
E50787Medicare UPIN
CA00A484821Medicaid
BX907XMedicare PIN