MEDICARE: DR. KENT L WELLISH M.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	207W00000X	Ophthalmology Physician	7032	NV
2	207W00000X	Ophthalmology Physician	G74385	CA
3	207W00000X	Ophthalmology Physician	21433	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180023250	OTHER	NV	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1952358426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT L WELLISH M.D.

Provider Business Mailing Address
First Line	:	2110 E FLAMINGO RD
Second Line	:	#210
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	702-733-2020
Fax Number	:	702-794-2797

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD
Second Line	:	#210
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	702-733-2020
Fax Number	:	702-794-2797

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	12/17/2008

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Directions to “ DR. KENT L WELLISH M.D.” Practice Location

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