Wilfred James Fennewald, LICENSED OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

SC2077 Issued in OH

Practice address

2737 Navarre Ave Ste 204
Oregon, OH 43616-3276

Phone

(419) 693-3376

Fax

(419) 693-7519

NPI assigned

Dec 14, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 8

Other names 1

• Mr. W James Fennewald Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• James Optical Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oregon, OH
  • NPI 1437329513
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1093790941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2737 NAVARRE AVE STE 204",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163276",
            "telephone_number": "419-693-3376",
            "fax_number": "419-693-7519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 NAVARRE AVE STE 204",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163276",
            "telephone_number": "419-693-3376",
            "fax_number": "419-693-7519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNEWALD",
        "first_name": "WILFRED",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "LICENSED OPTICIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FC0801X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": "OH",
            "license": "SC2077",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "OH",
            "license": "SC2077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "363492",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "OH2077",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0511637",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC",
            "identifier": "31106091100",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000155056",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT HEALTH CARE",
            "identifier": "10251",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "311060911001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "15295",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "W JAMES",
            "last_name": "FENNEWALD",
            "prefix": "MR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Family Internists of Ohio, Inc.
• Lawrence John Fanelly Jr., DO
• Andrea Farrell
• Rawish Fatima, MD
• Amanda Feher-Konczal, PT
• Fergosey, Inc.
• Everett E Ferradino, D.P.M.
• Husine Sam Fick, DDS
• Ajanae Fletcher
• Beverly Foltz, NP

• Optician in Oregon, OH
• Providers in Oregon, OH by specialty
• Optician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.