Provider Demographics
NPI:1164618245
Name:DRS. PANNER & WEN, PC
Entity Type:Organization
Organization Name:DRS. PANNER & WEN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-361-8284
Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5698
Mailing Address - Country:US
Mailing Address - Phone:703-361-8284
Mailing Address - Fax:703-361-0318
Practice Address - Street 1:8140 ASHTON AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5698
Practice Address - Country:US
Practice Address - Phone:703-361-8284
Practice Address - Fax:703-361-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
VV6441AMedicare PIN
C01538Medicare PIN
0244380001Medicare NSC