Provider Demographics
NPI:1487935730
Name:WELKE, RENAE ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:ELIZABETH
Last Name:WELKE
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 1:240 MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6200
Mailing Address - Country:US
Mailing Address - Phone:605-719-9499
Mailing Address - Fax:605-719-9509
Practice Address - Street 1:240 MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6200
Practice Address - Country:US
Practice Address - Phone:605-719-9499
Practice Address - Fax:605-719-9509
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026801800Medicaid
SD1487935730OtherBLUE CROSS BLUE SHIELD
WY154811500Medicaid
SD2004371Medicaid