Healthcare Provider Details

I. General information

NPI: 1770417461
Provider Name (Legal Business Name): CHRISTOPHER WELCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 FOWLER AVE
JOHNSON CITY NY
13790-2910
US

IV. Provider business mailing address

52 FOWLER AVE
JOHNSON CITY NY
13790-2910
US

V. Phone/Fax

Practice location:
  • Phone: 607-427-2735
  • Fax:
Mailing address:
  • Phone: 607-427-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006534-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: