Provider Demographics
NPI:1346235124
Name:WETZLER, CHRISTOPHER JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:WETZLER
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 1:4203 N SHERIDAN RD
Mailing Address - Street 2:SUITE A1-4
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7170
Mailing Address - Country:US
Mailing Address - Phone:309-686-0763
Mailing Address - Fax:309-685-8809
Practice Address - Street 1:4203 N SHERIDAN RD
Practice Address - Street 2:SUITE A1-4
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7170
Practice Address - Country:US
Practice Address - Phone:309-686-0763
Practice Address - Fax:309-685-8809
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-009360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410042675OtherRAILROAD MEDICARE
ILL94758Medicare ID - Type UnspecifiedMEDICARE NUMBER
ILU92778Medicare UPIN