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General NPI Number Information
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NPI Number | 1548415698
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Entity Type | Organization
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Legal Business Name | DAVID N. WELBORN, OD
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 262 MITYLENE PARK DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-3548
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Country | US
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Telephone | 334-260-8511
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Fax | 334-260-8755
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Provider Business Mailing Address
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Address Line | 262 MITYLENE PARK DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-3548
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Country | US
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Telephone | 334-260-8511
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Fax | 334-260-8755
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. NANCY PAULK
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Credential |
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Telephone | 334-260-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S626TA180
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License Number State | AL
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