Provider Demographics
NPI:1467564864
Name:WELLINGTON AND WEDDELL EYE CARE, PC
Entity Type:Organization
Organization Name:WELLINGTON AND WEDDELL EYE CARE, PC
Other - Org Name:WELLINGTON EYE CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:F
Authorized Official - Last Name:WEDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-533-7345
Mailing Address - Street 1:116 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3729
Mailing Address - Country:US
Mailing Address - Phone:574-533-7345
Mailing Address - Fax:574-533-5683
Practice Address - Street 1:116 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3729
Practice Address - Country:US
Practice Address - Phone:574-533-7345
Practice Address - Fax:574-533-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty