Provider Demographics
NPI:1063014173
Name:WOELFEL, WRAY ROBERT (OD)
Entity type:Individual
Prefix:
First Name:WRAY
Middle Name:ROBERT
Last Name:WOELFEL
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 1:247 S KERSEY RD
Mailing Address - Street 2:
Mailing Address - City:KERSEY
Mailing Address - State:PA
Mailing Address - Zip Code:15846-2229
Mailing Address - Country:US
Mailing Address - Phone:814-594-7887
Mailing Address - Fax:
Practice Address - Street 1:2546 RIMROCK AVE STE 100-B
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-8671
Practice Address - Country:US
Practice Address - Phone:970-208-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist