MEDICARE: DR. VALENCIA ROBERTSON WELLS 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	S-C08-TA-828	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01303269	OTHER	AL	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	102I410055	OTHER	AL	PTAN

General Provider Information

NPI Number	:	1659504504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALENCIA ROBERTSON WELLS O.D.

Provider Business Mailing Address
First Line	:	2014 MORRIS AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-4108
Country	:	US
Telephone Number	:	205-328-1744
Fax Number	:	205-328-4270

Provider Business Practice Location Address
First Line	:	2014 MORRIS AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-4108
Country	:	US
Telephone Number	:	205-328-1744
Fax Number	:	205-328-4270

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

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	01/14/2015

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