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NPI Code Detail

MEDICARE: WELLER INC

MEDICARE: WELLER INC
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
1156FX1800XOptician

General Provider Information

NPI Number : 1205984630
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLER INC
Provider Business Mailing Address
First Line : 2933 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1831
Country : US
Telephone Number : 503-232-5006
Fax Number : 503-239-3977
Provider Business Practice Location Address
First Line : 2933 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1831
Country : US
Telephone Number : 503-232-5006
Fax Number : 503-239-3977
Authorized Official
Title or Position : OWNER OPTICIAN
Name : MR. RICHARD W WELLER
Credential :
Telephone Number : 503-232-5006
Provider Enumeration Date : 01/08/2007
Last Update Date : 08/22/2020

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Directions to “WELLER INC ” Practice Location

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