Provider Demographics
NPI:1720185028
Name:WELLING, MARIANNE HINCK (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:HINCK
Last Name:WELLING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARIANNE
Other - Middle Name:HINK
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9709 THIRD AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2027
Mailing Address - Country:US
Mailing Address - Phone:206-525-5556
Mailing Address - Fax:206-525-0422
Practice Address - Street 1:9709 THIRD AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2027
Practice Address - Country:US
Practice Address - Phone:206-525-5556
Practice Address - Fax:206-525-0422
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023190Medicaid
WA2023190Medicaid
WAAB01117Medicare PIN