Provider Demographics
NPI:1194789529
Name:WETCHER, STEVEN PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:WETCHER
Suffix:
Gender:M
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:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:GREEN VILLAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07935-0283
Mailing Address - Country:US
Mailing Address - Phone:973-822-8199
Mailing Address - Fax:973-660-0420
Practice Address - Street 1:268 GREEN VILLAGE RD
Practice Address - Street 2:
Practice Address - City:GREEN VILLAGE
Practice Address - State:NJ
Practice Address - Zip Code:07935-3027
Practice Address - Country:US
Practice Address - Phone:973-822-8199
Practice Address - Fax:973-660-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00377500152W00000X
NJ27TO00018800152W00000X
PAOE005311P152W00000X
NYT003597-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WE467800Medicare ID - Type Unspecified
T81525Medicare UPIN