Provider Demographics
NPI:1558570515
Name:HERSHEL B WELTON, OD
Entity Type:Organization
Organization Name:HERSHEL B WELTON, OD
Other - Org Name:WELTON OPTOMETRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERSHEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-535-8404
Mailing Address - Street 1:303 W LINCOLN AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2936
Mailing Address - Country:US
Mailing Address - Phone:714-535-8404
Mailing Address - Fax:714-687-9848
Practice Address - Street 1:303 W LINCOLN AVE
Practice Address - Street 2:STE 120
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2936
Practice Address - Country:US
Practice Address - Phone:714-535-8404
Practice Address - Fax:714-687-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0101770Medicaid
CASD0046560Medicaid
CAWY059Medicare ID - Type Unspecified
CASD0101770Medicaid
CASD0046560Medicaid