Provider Demographics
NPI:1710920780
Name:WELLER, STEVEN CARROLL (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CARROLL
Last Name:WELLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WOLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17023-8665
Mailing Address - Country:US
Mailing Address - Phone:717-362-3014
Mailing Address - Fax:717-362-4193
Practice Address - Street 1:670 RISING SUN LN
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000385152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01864697Medicaid
MW0425315OtherDEA NUMBER
PA082305QTSMedicare ID - Type Unspecified
PA01864697Medicaid