Provider Demographics
NPI:1275519258
Name:JUSTIN C WEHR OD INC
Entity Type:Organization
Organization Name:JUSTIN C WEHR OD INC
Other - Org Name:THE EYE SITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEHR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-432-3384
Mailing Address - Street 1:1225 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2944
Mailing Address - Country:US
Mailing Address - Phone:740-432-3384
Mailing Address - Fax:740-439-0101
Practice Address - Street 1:1225 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2944
Practice Address - Country:US
Practice Address - Phone:740-432-3384
Practice Address - Fax:740-439-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT1957152W00000X
OHS.6562156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2188074Medicaid
OH2188074Medicaid
OH9349961Medicare PIN
OHU80227Medicare UPIN