MEDICARE: DAVID B.WOEHLKE, O.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA 0872	MD

General Provider Information

NPI Number	:	1164716064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID B.WOEHLKE, O.D., P.A.

Provider Business Mailing Address
First Line	:	6718A RITCHIE HWY
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2319
Country	:	US
Telephone Number	:	410-768-6101
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718A RITCHIE HWY
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2319
Country	:	US
Telephone Number	:	410-768-6101
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID B. WOEHLKE I
Credential	:	O.D.
Telephone Number	:	410-768-6101

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	08/01/2011

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