Provider Demographics
NPI:1457561250
Name:WEGENKE, ACASIA (CASEY) MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ACASIA (CASEY)
Middle Name:MARIE
Last Name:WEGENKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:7650 S 59TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3072
Practice Address - Country:US
Practice Address - Phone:602-237-3576
Practice Address - Fax:602-237-3668
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11449T152W00000X
AZOPT-002522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist