Provider Demographics
NPI:1912034208
Name:WEHNER, PAUL M (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:WEHNER
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 1:707 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-1627
Mailing Address - Country:US
Mailing Address - Phone:541-998-6454
Mailing Address - Fax:541-998-3876
Practice Address - Street 1:707 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-1627
Practice Address - Country:US
Practice Address - Phone:541-998-6454
Practice Address - Fax:541-998-3876
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2742ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU79387Medicare UPIN