Provider Demographics
NPI:1225076425
Name:WIENER, RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:WIENER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 N PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1315
Mailing Address - Country:US
Mailing Address - Phone:609-822-3995
Mailing Address - Fax:
Practice Address - Street 1:137 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1569
Practice Address - Country:US
Practice Address - Phone:856-227-5308
Practice Address - Fax:856-227-7986
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA2888152W00000X
NJTO000189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ149539Medicare ID - Type Unspecified
NJU26624Medicare UPIN