Provider Demographics
NPI:1841324027
Name:WOELTGE, DONALD GEORGE
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:GEORGE
Last Name:WOELTGE
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 1:2118 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7813
Mailing Address - Country:US
Mailing Address - Phone:605-348-4778
Mailing Address - Fax:605-343-7275
Practice Address - Street 1:2118 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7813
Practice Address - Country:US
Practice Address - Phone:605-348-4778
Practice Address - Fax:605-343-7275
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9281250Medicaid
SD0790800001Medicare ID - Type Unspecified