Provider Demographics
NPI:1336275122
Name:WESSNER, ALETHEA LENORE (OD)
Entity type:Individual
Prefix:
First Name:ALETHEA
Middle Name:LENORE
Last Name:WESSNER
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 1:231 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:570-345-6219
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU85803Medicare UPIN
PAWE049221Medicare ID - Type Unspecified