Provider Demographics
NPI:1891975975
Name:WEHR, JUSTIN C (OD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:WEHR
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 1:1225 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2944
Mailing Address - Country:US
Mailing Address - Phone:740-432-3384
Mailing Address - Fax:740-439-0101
Practice Address - Street 1:1225 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2944
Practice Address - Country:US
Practice Address - Phone:740-432-3384
Practice Address - Fax:740-439-0101
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5080T1957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2188074Medicaid
OHU80227Medicare UPIN
OH2188074Medicaid