Provider Demographics
NPI:1235234634
Name:WENDEL, ROBERT THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:WENDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 J ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3631
Mailing Address - Country:US
Mailing Address - Phone:916-454-6191
Mailing Address - Fax:916-454-1036
Practice Address - Street 1:3939 J ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3631
Practice Address - Country:US
Practice Address - Phone:916-454-6191
Practice Address - Fax:916-454-1036
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43291207W00000X
NV6988207W00000X
CAG043291207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0199874OtherDEPT. OF LABOR WASHINGTON
CA00G432910OtherBLUE SHIELD
CA00G432910Medicaid
CA180009834OtherRAILROAD MEDICARE
CA00G432910OtherBLUE SHIELD
WA0199874OtherDEPT. OF LABOR WASHINGTON
A49301Medicare UPIN
CA180009834OtherRAILROAD MEDICARE
CA00G432913Medicare PIN
CA00G432910Medicaid
CA00G432910Medicare PIN