Provider Demographics
NPI:1225148026
Name:WECKER, ANTHONY ALAN (OD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALAN
Last Name:WECKER
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 1:110 N MICHIGAN AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1402
Mailing Address - Country:US
Mailing Address - Phone:231-287-6721
Mailing Address - Fax:
Practice Address - Street 1:21400 PERRY AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9262
Practice Address - Country:US
Practice Address - Phone:231-796-5643
Practice Address - Fax:231-796-5744
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N38790Medicare ID - Type Unspecified
MIH36905Medicare UPIN