Provider Demographics
NPI:1932131174
Name:WELTMER, JEFF W (OD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:W
Last Name:WELTMER
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 1:1295 E 151ST ST STE 3
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3429
Mailing Address - Country:US
Mailing Address - Phone:913-782-4983
Mailing Address - Fax:
Practice Address - Street 1:1295 E 151ST ST STE 3
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3429
Practice Address - Country:US
Practice Address - Phone:913-782-4983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1043-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KA1440OtherMEDICARE PTAN
KSKA1440Medicare PIN
KSU16464Medicare UPIN
KA1440OtherMEDICARE PTAN