Provider Demographics
NPI:1144295031
Name:WAHLMEIER, MARK F (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:WAHLMEIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701
Mailing Address - Country:US
Mailing Address - Phone:785-462-8231
Mailing Address - Fax:785-462-2307
Practice Address - Street 1:1018 MAIN AVE
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-2943
Practice Address - Country:US
Practice Address - Phone:785-899-3654
Practice Address - Fax:785-899-3308
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2677152W00000X
KS1587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100369640AMedicaid
KS410044445OtherRAILROAD MEDICARE
KS100369640AMedicaid
KS650751Medicare ID - Type Unspecified