Provider Demographics
NPI:1609484179
Name:WELNAK, HEIDI H (OD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:H
Last Name:WELNAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:H
Other - Last Name:OLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2225
Mailing Address - Country:US
Mailing Address - Phone:802-447-8700
Mailing Address - Fax:802-447-1500
Practice Address - Street 1:5222 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9700
Practice Address - Country:US
Practice Address - Phone:802-366-8050
Practice Address - Fax:802-366-8045
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0133931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT030.0133931OtherVT LICENSE