Provider Demographics
NPI:1013368380
Name:WERNCKE, CHELSEA (OD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:WERNCKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 OAK PARK RD NE
Mailing Address - Street 2:
Mailing Address - City:NEW SALISBURY
Mailing Address - State:IN
Mailing Address - Zip Code:47161-8401
Mailing Address - Country:US
Mailing Address - Phone:812-366-3147
Mailing Address - Fax:812-366-3151
Practice Address - Street 1:8010 OAK PARK RD NE
Practice Address - Street 2:
Practice Address - City:NEW SALISBURY
Practice Address - State:IN
Practice Address - Zip Code:47161-8401
Practice Address - Country:US
Practice Address - Phone:812-366-3147
Practice Address - Fax:812-366-3151
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003984A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201370710Medicaid
IN201370710Medicaid