Provider Demographics
NPI:1598700098
Name:DR. STEVEN C. WELLER, INC.
Entity Type:Organization
Organization Name:DR. STEVEN C. WELLER, INC.
Other - Org Name:RISING SUN EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-692-2122
Mailing Address - Street 1:249 WOLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17023-8665
Mailing Address - Country:US
Mailing Address - Phone:717-362-3014
Mailing Address - Fax:717-362-4193
Practice Address - Street 1:670 RISING SUN LN
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1245
Practice Address - Country:US
Practice Address - Phone:717-692-2122
Practice Address - Fax:717-692-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07795176Medicaid
PA059980Medicare ID - Type Unspecified
PA07795176Medicaid
PA059980Medicare PIN