Provider Demographics
NPI:1265688014
Name:ANTHONY A WECKER OD PLLC
Entity type:Organization
Organization Name:ANTHONY A WECKER OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-796-5643
Mailing Address - Street 1:21400 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9262
Mailing Address - Country:US
Mailing Address - Phone:231-796-5643
Mailing Address - Fax:231-796-5744
Practice Address - Street 1:21400 PERRY AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9262
Practice Address - Country:US
Practice Address - Phone:231-796-5643
Practice Address - Fax:231-796-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty