Healthcare Provider Details

I. General information

NPI: 1336134436
Provider Name (Legal Business Name): DAVID M WELLS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11088 N US HIGHWAY 15 501
ABERDEEN NC
28315-2385
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3970
US

V. Phone/Fax

Practice location:
  • Phone: 910-693-1226
  • Fax: 910-692-8983
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0993
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: