Provider Demographics
NPI:1336134436
Name:WELLS, DAVID M (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:WELLS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:11088 N US HIGHWAY 15 501
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2385
Practice Address - Country:US
Practice Address - Phone:910-693-1226
Practice Address - Fax:910-692-8983
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909964Medicaid
NC09964OtherBLUE CROSS
NCP00630210OtherRAILROAD MEDICARE
NC246617NMedicare PIN