Provider Demographics
NPI:1700218583
Name:WELLS, CAROLINE (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 FRY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5809
Mailing Address - Country:US
Mailing Address - Phone:281-828-2020
Mailing Address - Fax:281-828-2022
Practice Address - Street 1:1350 FRY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5809
Practice Address - Country:US
Practice Address - Phone:281-828-2020
Practice Address - Fax:281-828-2022
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8294T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY22868Medicare UPIN