Provider Demographics
NPI:1922236678
Name:WOLK, DEANNE MICHELLE (OD)
Entity Type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:MICHELLE
Last Name:WOLK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:DEANNE
Other - Middle Name:MICHELLE
Other - Last Name:WEHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:223 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1952
Mailing Address - Country:US
Mailing Address - Phone:636-937-2399
Mailing Address - Fax:636-937-4683
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-1952
Practice Address - Country:US
Practice Address - Phone:636-937-2399
Practice Address - Fax:636-937-4683
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017070152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1922236678Medicaid
MO1922236678Medicaid
MOMA5227041Medicare UPIN