Healthcare Provider Details

I. General information

NPI: 1801893896
Provider Name (Legal Business Name): JOHN MARK WELSH JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WESTCHESTER DR
SALINA KS
67401-7447
US

IV. Provider business mailing address

900 WESTCHESTER DR
SALINA KS
67401-7447
US

V. Phone/Fax

Practice location:
  • Phone: 785-823-7403
  • Fax: 785-825-8857
Mailing address:
  • Phone: 785-823-7403
  • Fax: 785-825-8857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1077-3
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: