Provider Demographics
NPI:1689219222
Name:DR. STEVEN C. WELLER, INC.
Entity Type:Organization
Organization Name:DR. STEVEN C. WELLER, INC.
Other - Org Name:RISING SUN EYECARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-692-2122
Mailing Address - Street 1:670 RISING SUN RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-1245
Mailing Address - Country:US
Mailing Address - Phone:717-692-2122
Mailing Address - Fax:717-692-4183
Practice Address - Street 1:670 RISING SUN RD
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:2019-11-07
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1598700098OtherNPI