Provider Demographics
NPI:1003868571
Name:HALLIER, WENDY SUE (OD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:HALLIER
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 CANTER CT
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-4026
Mailing Address - Country:US
Mailing Address - Phone:740-816-4115
Mailing Address - Fax:
Practice Address - Street 1:35901 CHESTER RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1005
Practice Address - Country:US
Practice Address - Phone:440-937-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2178647Medicaid
OHHA4108824Medicare ID - Type Unspecified
OHU43370Medicare UPIN
OH2178647Medicaid