Provider Demographics
NPI:1750468302
Name:WELLS, R. DEAN
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:DEAN
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N BECHTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2082
Mailing Address - Country:US
Mailing Address - Phone:937-324-5523
Mailing Address - Fax:923-324-0788
Practice Address - Street 1:900 N BECHTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2082
Practice Address - Country:US
Practice Address - Phone:937-324-5523
Practice Address - Fax:923-324-0788
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2805 T695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058566Medicaid
OH0058566Medicaid
OHWE0157891Medicare ID - Type Unspecified