Provider Demographics
NPI:1609883859
Name:WERNER, F. JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:F.
Middle Name:JOSEPH
Last Name:WERNER
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 1:336 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-1407
Mailing Address - Country:US
Mailing Address - Phone:610-863-5665
Mailing Address - Fax:610-863-8878
Practice Address - Street 1:336 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1407
Practice Address - Country:US
Practice Address - Phone:610-863-5665
Practice Address - Fax:610-863-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012728740001Medicaid
PA0012728740001Medicaid
PA532361Medicare PIN