Provider Demographics
NPI:1881966265
Name:DR. ALETHEA WESSNER LLC
Entity type:Organization
Organization Name:DR. ALETHEA WESSNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALETHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-345-0188
Mailing Address - Street 1:231 S TULPEHOCKEN ST
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-1037
Mailing Address - Country:US
Mailing Address - Phone:570-345-0188
Mailing Address - Fax:570-345-0267
Practice Address - Street 1:231 S TULPEHOCKEN ST
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-1037
Practice Address - Country:US
Practice Address - Phone:570-345-0188
Practice Address - Fax:570-345-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1881966265OtherNPI
PA1881966265OtherNPI