Wells Vision and Laser Eye Center, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2263 Issued in OK

Legal business name

WELLS VISION AND LASER EYE CENTER, LLC

Practice address

4012 Commons Dr W Ste 110
Destin, FL 32541-8424

Phone

(850) 424-6677

Fax

(850) 424-7271

NPI assigned

Jan 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin W Wells, ODNPI 1194809178

Title

President/Owner

Phone

(850) 424-6677

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin W Wells, OD

  • Optometrist
  • Destin, FL
  • NPI 1194809178
  Medicare reassignment NPD Authorized official
• Natalie Pelly, OD

  • Optometrist
  • Destin, FL
  • NPI 1841862356
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1356498232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 COMMONS DR W STE 110",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325418424",
            "telephone_number": "850-424-6677",
            "fax_number": "850-424-7271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4012 COMMONS DR W STE 110",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325418424",
            "telephone_number": "850-424-6677",
            "fax_number": "850-424-7271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLS VISION AND LASER EYE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "850-424-6677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2263",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "OK",
            "license": "2263",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME SUPPLIER",
            "identifier": "1315210001",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100763300A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandrea Warren, FNP-C, CDE, BC-ADM
• Raymond Neil Weber, COTA
• Melissa Payne Weiner
• Melissa L Welch, PHD, LMFT
• Kelly Layton Weldon, FNP-C
• Alvin F Wells, MD
• Kevin W Wells, OD
• Whidden, Inc.
• Jeremy Whidden
• Jessica Whidden, DC

• Optometrist in Destin, FL
• Providers in Destin, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.