MEDICARE: DR. DAVID NEIL WELBORN 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	S626TA180	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410016238	OTHER	AL	RR MEDICARE
3	0125920001	OTHER	AL	MEDICARE REGIONAL DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51058466	OTHER	AL	BCBS
5	511-12625	OTHER	AL	BCBS
6	630958794	OTHER	AL	TRICARE

General Provider Information

NPI Number	:	1598747339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID NEIL WELBORN O.D.

Provider Business Mailing Address
First Line	:	PO BOX 515
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35011-0515
Country	:	US
Telephone Number	:	256-329-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 HERITAGE DR
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3031
Country	:	US
Telephone Number	:	256-329-2020
Fax Number	:

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	11/01/2011

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Directions to “ DR. DAVID NEIL WELBORN O.D.” Practice Location

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