Provider Demographics
NPI:1659471316
Name:TAO, WENHONG (OD)
Entity Type:Individual
Prefix:DR
First Name:WENHONG
Middle Name:
Last Name:TAO
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 1:85 STATE ROUTE 101A
Mailing Address - Street 2:C/O WAL-MART VISION CENTER
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2216
Mailing Address - Country:US
Mailing Address - Phone:603-673-6295
Mailing Address - Fax:603-673-6257
Practice Address - Street 1:85 STATE ROUTE 101A
Practice Address - Street 2:C/O WAL-MART VISION CENTER
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2216
Practice Address - Country:US
Practice Address - Phone:603-673-6295
Practice Address - Fax:603-673-6257
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0692152W00000X
MA4172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOP1770OtherEYEMED
NH10148OtherSPECTERA VISION PLAN
NHNH0672OtherEYEMED
NH33741OtherAVESIS
MA0704202Medicaid
NH2538668OtherAETNA
NH30351284Medicaid
NH09Y003053NH01OtherANTHEM BCBS
MAW16228OtherBCBS OF MA
NH4123904OtherMVP HEALTHCARE
MAOP1770OtherEYEMED
MAW17292Medicare ID - Type Unspecified
NH30351284Medicaid