Individual
DR. THAD DUSTIN WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
105 ROBINS WAY, SUITE 206, RUSSELLVILLE, KY 42276-1129
(270) 726-2022
(270) 726-2035
Mailing address
105 ROBINS WAY, SUITE 206, RUSSELLVILLE, KY 42276-1129
(270) 726-2022
(270) 726-2035
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1770DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100085750
—
KY
Enumeration date
07/13/2009
Last updated
10/02/2012
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