Provider Demographics
NPI:1538113832
Name:WANDER, ARDEN H (M D)
Entity Type:Individual
Prefix:
First Name:ARDEN
Middle Name:H
Last Name:WANDER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631995
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1995
Mailing Address - Country:US
Mailing Address - Phone:513-475-7294
Mailing Address - Fax:513-475-7369
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-7294
Practice Address - Fax:513-475-7369
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.030348207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0286346Medicaid
OH690872OtherBWC
A74408Medicare UPIN
OHWA0383985Medicare ID - Type Unspecified