Provider Demographics
NPI:1568481208
Name:WENER, HARVEY M (OD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:M
Last Name:WENER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:HARVEY
Other - Middle Name:M
Other - Last Name:WENER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2150 COVINGTON PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-6907
Mailing Address - Country:US
Mailing Address - Phone:901-381-9483
Mailing Address - Fax:901-382-5410
Practice Address - Street 1:2150 COVINGTON PIKE STE A
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-6907
Practice Address - Country:US
Practice Address - Phone:901-381-9483
Practice Address - Fax:901-382-5410
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN523152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3596260Medicare PIN
TNU01242Medicare UPIN