Provider Demographics
NPI:1598879553
Name:WIENS, AARON MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:MARK
Last Name:WIENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 E HERNDON AVE
Mailing Address - Street 2:SUITE401
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:1360 E HERNDON AVE
Practice Address - Street 2:SUITE401
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5010
Practice Address - Fax:559-449-5014
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598879553Medicaid
CAZZZ13882ZOtherMEDICARE GROUP PTAN
CAZZZ13883ZOtherMEDICARE GROUP PTAN
CAZZZ13844ZOtherMEDICARE GROUP PTAN
ZZZ13845ZOtherMEDICARE GROUP PTAN
CAZZZ13463ZOtherMEDICARE GROUP PTAN
CASD0132321Medicare PIN
CASD0132320Medicare PIN
CASD0132324Medicare PIN
CAZZZ13844ZOtherMEDICARE GROUP PTAN
CAZZZ13882ZOtherMEDICARE GROUP PTAN
CA1598879553Medicaid