Provider Demographics
NPI:1558716191
Name:WAHL, CHELSEA RENEE
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:RENEE
Last Name:WAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 SOUTHWEST PWKY
Mailing Address - Street 2:BLDG 6, STE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:228-216-9103
Mailing Address - Fax:
Practice Address - Street 1:7415 SOUTHWEST PWKY
Practice Address - Street 2:BLDG 6, STE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:512-328-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3319152W00000X
TX9708T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist