Provider Demographics
NPI:1568727311
Name:WENZEL, VICTORIA ROSE (OD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:WENZEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:WHITTENHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 TEMPLETON DR
Mailing Address - Street 2:F
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7019
Mailing Address - Country:US
Mailing Address - Phone:630-554-8002
Mailing Address - Fax:630-554-8095
Practice Address - Street 1:83 TEMPLETON DR
Practice Address - Street 2:F
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7019
Practice Address - Country:US
Practice Address - Phone:630-554-8002
Practice Address - Fax:630-554-8095
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist