Provider Demographics
NPI:1346294295
Name:WEDUL, MARK V (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:V
Last Name:WEDUL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1570 CONCORDIA AVE STE 202
Mailing Address - Street 2:LEXINGTON EYE ASSOCIATES PA
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5345
Mailing Address - Country:US
Mailing Address - Phone:651-646-7419
Mailing Address - Fax:651-637-2778
Practice Address - Street 1:1570 CONCORDIA AVE STE 202
Practice Address - Street 2:LEXINGTON EYE ASSOCIATES PA
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5345
Practice Address - Country:US
Practice Address - Phone:651-646-7419
Practice Address - Fax:651-646-7419
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-04-07
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Provider Licenses
StateLicense IDTaxonomies
MN29010207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN664275600Medicaid
MN180000994Medicare PIN
MN664275600Medicaid