Provider Demographics
NPI:1396114807
Name:WENG, MICHAEL (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WENG
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5313
Mailing Address - Country:US
Mailing Address - Phone:773-857-3328
Mailing Address - Fax:
Practice Address - Street 1:2915 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5313
Practice Address - Country:US
Practice Address - Phone:773-857-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician