Provider Demographics
NPI:1164126827
Name:GEARHART, WENDY DAWN (OP012976-S)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:DAWN
Last Name:GEARHART
Suffix:
Gender:F
Credentials:OP012976-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2165
Mailing Address - Country:US
Mailing Address - Phone:740-474-8669
Mailing Address - Fax:740-474-7970
Practice Address - Street 1:1470 S COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2165
Practice Address - Country:US
Practice Address - Phone:740-474-8669
Practice Address - Fax:740-474-7970
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.012976-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician