Provider Demographics
NPI:1801833991
Name:WELLS, BRAD F (OD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:F
Last Name:WELLS
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 1:3906 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3131
Mailing Address - Country:US
Mailing Address - Phone:918-585-1523
Mailing Address - Fax:918-584-5520
Practice Address - Street 1:3906 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3131
Practice Address - Country:US
Practice Address - Phone:918-585-1523
Practice Address - Fax:918-584-5520
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00178439OtherRAIL ROAD MEDICARE
OK200038340AMedicaid
OK200038340AMedicaid
OK244422401Medicare ID - Type Unspecified