Provider Demographics
NPI:1659698728
Name:ESSIX, WENDELL A
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:A
Last Name:ESSIX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 #1 14TH STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-541-9867
Mailing Address - Fax:
Practice Address - Street 1:1417 14TH STREET SOUTH
Practice Address - Street 2:APT 1
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-541-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician