Provider Demographics
NPI:1588644033
Name:WOLMER, MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WOLMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:WOLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5620
Mailing Address - Country:US
Mailing Address - Phone:203-792-2020
Mailing Address - Fax:203-792-9998
Practice Address - Street 1:62 NORTH ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5620
Practice Address - Country:US
Practice Address - Phone:203-792-2020
Practice Address - Fax:203-792-9998
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1639400112OtherNPI TYPE II
CT1588644033OtherNPI TYPE I
CTT22038Medicare UPIN
CT1588644033OtherNPI TYPE I