Provider Demographics
NPI:1619099231
Name:WELCH, DEBRA INEZ (ABOC AMERICAN BO)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:INEZ
Last Name:WELCH
Suffix:
Gender:F
Credentials:ABOC AMERICAN BO
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:DOYLE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ABOC
Mailing Address - Street 1:1509 A. NORTH PINE STREET
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-0000
Mailing Address - Country:US
Mailing Address - Phone:337-463-9821
Mailing Address - Fax:337-463-9821
Practice Address - Street 1:1509 A. NORTH PINE STREET
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-0000
Practice Address - Country:US
Practice Address - Phone:337-463-9821
Practice Address - Fax:337-463-9821
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAABO CERTIFIED 21999156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1569178Medicaid
LA1619099231Medicaid