Provider Demographics
NPI:1881691319
Name:WELLS, DAVID RAY (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
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 1:906 W PINE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3599
Mailing Address - Country:US
Mailing Address - Phone:336-719-2000
Mailing Address - Fax:888-241-5078
Practice Address - Street 1:906 W PINE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3599
Practice Address - Country:US
Practice Address - Phone:336-719-2000
Practice Address - Fax:888-241-5078
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890902LMedicaid
NC2468666EMedicare PIN
NCU45122Medicare UPIN
NC890902LMedicaid