Provider Demographics
NPI:1841412350
Name:WELKER, RONALD P
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:P
Last Name:WELKER
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 1:241B STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2659
Mailing Address - Country:US
Mailing Address - Phone:440-593-6205
Mailing Address - Fax:440-593-6205
Practice Address - Street 1:256 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2652
Practice Address - Country:US
Practice Address - Phone:440-593-6205
Practice Address - Fax:440-593-6205
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4091156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP2070OtherEYEMED PROVIDER #
363227OtherNVA #
OP2070OtherEYEMED PROVIDER #