Provider Demographics
NPI:1124047014
Name:WOEHLKE, DAVID BRUCE (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:WOEHLKE
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 1:211 COPPERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2700
Mailing Address - Country:US
Mailing Address - Phone:410-544-0305
Mailing Address - Fax:
Practice Address - Street 1:6718 A RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-768-6101
Practice Address - Fax:410-768-4682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist