Provider Demographics
NPI:1295768042
Name:WELDON, CHRISTINE MARIE (OD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:WELDON
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 1:2139 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1122
Mailing Address - Country:US
Mailing Address - Phone:215-745-1444
Mailing Address - Fax:215-745-1448
Practice Address - Street 1:2139 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19149-1122
Practice Address - Country:US
Practice Address - Phone:215-745-1444
Practice Address - Fax:215-745-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE008528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5506380001Medicare NSC
PA063487Medicare PIN
PAU92072Medicare UPIN