Healthcare Provider Details

I. General information

NPI: 1952363897
Provider Name (Legal Business Name): DENISE L WELKER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FAIRINGTON DR
SIDNEY OH
45365-8913
US

IV. Provider business mailing address

1086 FAIRINGTON DR
SIDNEY OH
45365-8913
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-9197
  • Fax: 937-492-1901
Mailing address:
  • Phone: 937-492-9197
  • Fax: 937-492-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: