Provider Demographics
NPI:1134234644
Name:WEMHOENER, BRADLEY J (OD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:WEMHOENER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3046 LAVON DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-8794
Mailing Address - Country:US
Mailing Address - Phone:972-495-8998
Mailing Address - Fax:972-496-1535
Practice Address - Street 1:3046 LAVON DR
Practice Address - Street 2:SUITE 130
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-8794
Practice Address - Country:US
Practice Address - Phone:972-495-8998
Practice Address - Fax:972-496-1535
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX5469T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist