Provider Demographics
NPI:1548288186
Name:WIEDER, RICHARD H (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:WIEDER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-273-0020
Mailing Address - Fax:314-273-0033
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DEPT OPTHALMOLOGY, STE 2500
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-273-0020
Practice Address - Fax:314-273-0033
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO114614207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203768809Medicaid
MO203768809Medicaid
IL036079830Medicaid
MO089010103Medicare PIN