Provider Demographics
NPI:1710117197
Name:WELLS, TASCHA DANIELLE (OD)
Entity Type:Individual
Prefix:
First Name:TASCHA
Middle Name:DANIELLE
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 1:8145 W SAHARA AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1995
Mailing Address - Country:US
Mailing Address - Phone:702-360-0106
Mailing Address - Fax:702-360-1123
Practice Address - Street 1:8145 W SAHARA AVE STE 510
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1995
Practice Address - Country:US
Practice Address - Phone:702-360-0106
Practice Address - Fax:702-360-1123
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist