Provider Demographics
NPI:1346981941
Name:RENAE E WELKE OD LLC
Entity Type:Organization
Organization Name:RENAE E WELKE OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WELKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-206-0208
Mailing Address - Street 1:2308 HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-3336
Mailing Address - Country:US
Mailing Address - Phone:605-206-0208
Mailing Address - Fax:
Practice Address - Street 1:2120 LAZELLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1316
Practice Address - Country:US
Practice Address - Phone:605-347-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty