Provider Demographics
NPI:1952363897
Name:WELKER, DENISE L (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:L
Last Name:WELKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8913
Mailing Address - Country:US
Mailing Address - Phone:937-492-9197
Mailing Address - Fax:937-492-1901
Practice Address - Street 1:1086 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8913
Practice Address - Country:US
Practice Address - Phone:937-492-9197
Practice Address - Fax:937-492-1901
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0669683Medicaid
OH0176440001OtherDMERC
OH0176440004OtherDMERC
OH0669683Medicaid
OH0605077Medicare PIN
OH0176440001OtherDMERC