Provider Demographics
NPI:1871871905
Name:WEN, SAMUEL C (OD)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:C
Last Name:WEN
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 1:4703 APPLE ROCK CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3069
Mailing Address - Country:US
Mailing Address - Phone:832-971-8910
Mailing Address - Fax:
Practice Address - Street 1:4703 APPLE ROCK CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3069
Practice Address - Country:US
Practice Address - Phone:832-971-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7705T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist