Provider Demographics
NPI:1679751184
Name:JOHN D WELLWOOD
Entity Type:Organization
Organization Name:JOHN D WELLWOOD
Other - Org Name:SEMLER OPTICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-345-8734
Mailing Address - Street 1:1350 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3728
Mailing Address - Country:US
Mailing Address - Phone:541-345-8734
Mailing Address - Fax:541-434-0102
Practice Address - Street 1:1350 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3728
Practice Address - Country:US
Practice Address - Phone:541-345-8734
Practice Address - Fax:541-434-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2385AT1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158916Medicaid
OR158916Medicaid
1313680001Medicare NSC
R106804Medicare PIN