Provider Demographics
NPI:1619979911
Name:HARNISH, WESLEY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:JAMES
Last Name:HARNISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 ALKYRE RUN STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6910
Mailing Address - Country:US
Mailing Address - Phone:614-890-5692
Mailing Address - Fax:614-890-5629
Practice Address - Street 1:450 ALKYRE RUN STE 100
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6910
Practice Address - Country:US
Practice Address - Phone:614-890-5692
Practice Address - Fax:614-890-5629
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053294207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0739464Medicaid
OH4230712OtherATENA PROVIDER #
OH995169-0OtherBWC PROVIDER #
OHCA8572OtherRR GROUP
OH119353OtherANTHEM PROVIDER #
OH180006677OtherRAILROAD
OH180006677OtherRAILROAD
0634243Medicare PIN