Provider Demographics
NPI:1043248289
Name:WELLER, ERIK GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:GEORGE
Last Name:WELLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-1370
Mailing Address - Country:US
Mailing Address - Phone:717-692-2318
Mailing Address - Fax:717-692-4183
Practice Address - Street 1:670 RISING SUN LN
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1245
Practice Address - Country:US
Practice Address - Phone:717-692-2122
Practice Address - Fax:717-692-4183
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWE1696784Medicaid
PA091450QTSMedicare ID - Type Unspecified
PAVO5217Medicare UPIN