Active NPI
David Bruce Woehlke, OD
- Optometrist
- Glen Burnie, MD
National Provider Identifier
1124047014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TA0872
- Practice address
- 6718 A Ritchie Highway
Glen Burnie, MD 21061 - Phone
- (410) 768-6101
- Fax
- (410) 768-4682
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA0872 | MD | Primary |
Addresses
Primary practice location
6718 A Ritchie Highway
Glen Burnie, MD 21061
Mailing address
211 Copperwood CT
Millersville, MD 21108-2700
Phone (410) 544-0305
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA0872 | MD | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124047014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 COPPERWOOD CT",
"city": "MILLERSVILLE",
"state": "MD",
"postal_code": "211082700",
"telephone_number": "410-544-0305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6718 A RITCHIE HIGHWAY",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "21061",
"telephone_number": "410-768-6101",
"fax_number": "410-768-4682"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOEHLKE",
"first_name": "DAVID",
"middle_name": "BRUCE",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA0872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Burnie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.