Provider Demographics
NPI:1376806034
Name:WEN, JOANNA LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:LYNNE
Last Name:WEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8140 ASHTON AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5699
Mailing Address - Country:US
Mailing Address - Phone:703-361-8284
Mailing Address - Fax:703-361-0318
Practice Address - Street 1:8140 ASHTON AVE STE 115
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5699
Practice Address - Country:US
Practice Address - Phone:703-361-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist