Healthcare Provider Details

I. General information

NPI: 1366899403
Provider Name (Legal Business Name): CHRISTINA MICHELLE WELLING O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E 86TH ST SUITE #2
INDIANAPOLIS IN
46240-6859
US

IV. Provider business mailing address

860 E 86TH ST SUITE #2
INDIANAPOLIS IN
46240-6859
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-7755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003952A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: