Provider Demographics
NPI:1891798229
Name:WESLEY, CHARLES REEDER (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:REEDER
Last Name:WESLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18077 RIVER AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8311
Mailing Address - Country:US
Mailing Address - Phone:317-773-5153
Mailing Address - Fax:317-773-6452
Practice Address - Street 1:18077 RIVER AVE
Practice Address - Street 2:STE 103
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8311
Practice Address - Country:US
Practice Address - Phone:317-773-5153
Practice Address - Fax:317-773-6452
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01035260A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100317820AMedicaid
D94768Medicare UPIN
311600BMedicare ID - Type Unspecified