Provider Demographics
NPI:1730763152
Name:WNUK, RICHARD (RT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:WNUK
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 E LUPINE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2029
Mailing Address - Country:US
Mailing Address - Phone:856-979-4062
Mailing Address - Fax:
Practice Address - Street 1:3249 E LUPINE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-2029
Practice Address - Country:US
Practice Address - Phone:856-979-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ528772156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist