Healthcare Provider Details

I. General information

NPI: 1710920780
Provider Name (Legal Business Name): STEVEN CARROLL WELLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/07/2023
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 Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000385
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: