Organization
WELLS VISION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHANNING WELLS OD (OPTOMETRIST)
(601) 946-5492
Entity
Organization
Contact information
Practice address
960 BROOKWAY BLVD, BROOKHAVEN, MS 39601-2644
(601) 823-4494
Mailing address
1390 MOSES RD, RAYMOND, MS 39154-8943
(601) 946-5492
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
916
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04802528
—
MS
Enumeration date
02/01/2018
Last updated
02/01/2018
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