MEDICARE: CHRISTINE MARIE WELDON O.D.

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	OE008528	PA

General Provider Information

NPI Number	:	1295768042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MARIE WELDON O.D.

Provider Business Mailing Address
First Line	:	2139 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1122
Country	:	US
Telephone Number	:	215-745-1444
Fax Number	:	215-745-1448

Provider Business Practice Location Address
First Line	:	2139 COTTMAN AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19149-1122
Country	:	US
Telephone Number	:	215-745-1444
Fax Number	:	215-745-1448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/23/2016

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