Provider Demographics
NPI:1710972054
Name:WOHLGEMUTH, JAMES MIKEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MIKEAL
Last Name:WOHLGEMUTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-0609
Mailing Address - Country:US
Mailing Address - Phone:817-295-5601
Mailing Address - Fax:817-295-1884
Practice Address - Street 1:201 NW RENFRO ST
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4113
Practice Address - Country:US
Practice Address - Phone:817-295-5601
Practice Address - Fax:817-295-1884
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2080T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E31AOtherBCBS OF TEXAS
TXT16711Medicare UPIN
TX0645990001Medicare NSC
TX00E31AOtherBCBS OF TEXAS