Provider Demographics
NPI:1659413417
Name:CACIOPPO, WENDY KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:KATHERINE
Last Name:CACIOPPO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N ST SE BLDG 175
Mailing Address - Street 2:WNY BHC OPTOMETRY CLINIC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20374-5162
Mailing Address - Country:US
Mailing Address - Phone:202-433-0503
Mailing Address - Fax:
Practice Address - Street 1:915 N ST SE BLDG 175
Practice Address - Street 2:WNY BHC OPTOMETRY CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:202-433-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005019549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist