Provider Demographics
NPI:1174108534
Name:WEDEL, TODD ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANDREW
Last Name:WEDEL
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 1:134 CENTRAL WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6106
Mailing Address - Country:US
Mailing Address - Phone:425-889-2020
Mailing Address - Fax:425-739-0601
Practice Address - Street 1:1130 S MICHIGAN AVE APT 2108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2320
Practice Address - Country:US
Practice Address - Phone:972-979-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61173002152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program