Wandzilak, Theodore M

Wandzilak, Theodore M is an sole proprietor health care provider with primary practice located at 1348 Poplar Level Rd , Louisville KY 40217-1307. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Wandzilak, Theodore M can be contacted via phone (502) 634-8100.

Contact Information

Primary practice address
1348 Poplar Level Rd Louisville KY 40217-1307
Phone: (502) 634-8100
Fax: (502) 637-6396
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 22152 Kentucky

Profile Details

NPI number 1013909753
LBN Legal business name Wandzilak, Theodore M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 18th, 2005
Last updated Jan 9th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013909753 NPPES
Kentucky MEDICAID 64221526

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