Healthcare Provider Details

I. General information

NPI: 1598700098
Provider Name (Legal Business Name): DR. STEVEN C. WELLER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 RISING SUN LN
MILLERSBURG PA
17061-1245
US

IV. Provider business mailing address

249 WOLAND RD
ELIZABETHVILLE PA
17023-8665
US

V. Phone/Fax

Practice location:
  • Phone: 717-692-2122
  • Fax: 717-692-4183
Mailing address:
  • Phone: 717-362-3014
  • Fax: 717-362-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000385
License Number StatePA

VIII. Authorized Official

Name: DR. STEVEN C. WELLER
Title or Position: MANAGING PARTNER
Credential: O.D.
Phone: 717-692-2122