Provider Demographics
NPI:1629097332
Name:WELDER, WILLIAM J (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:WELDER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:315 11TH ST N
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4101
Mailing Address - Country:US
Mailing Address - Phone:701-642-4090
Mailing Address - Fax:701-642-9424
Practice Address - Street 1:315 11TH ST N
Practice Address - Street 2:SUITE A
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4101
Practice Address - Country:US
Practice Address - Phone:701-642-4090
Practice Address - Fax:701-642-9424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDND0534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP002074083OtherRAILROAD MEDICARE
MN545318600Medicaid
ND624891032463OtherPREFERRED ONE
ND60480Medicaid
MN4C633WEOtherBCBS
MN2202014OtherMEDICA
ND25386OtherBCBS ND
MN545318600OtherMINNESOTA MEDICAL ASSISTANCE
NDU56508Medicare UPIN
ND5567660001Medicare NSC
ND624891032463OtherPREFERRED ONE