Provider Demographics
NPI:1295046175
Name:WEHNER, MARIE E (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:E
Last Name:WEHNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 TESSON FERRY PROFESSIONAL CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1250
Mailing Address - Country:US
Mailing Address - Phone:314-843-5700
Mailing Address - Fax:
Practice Address - Street 1:12121 TESSON FERRY PROFESSIONAL CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1250
Practice Address - Country:US
Practice Address - Phone:314-843-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9900000920Medicare NSC
MO0682680001Medicare PIN
MO870155271Medicare PIN