Provider Demographics
NPI:1053936195
Name:WELLFORD, CORBIN LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:CORBIN
Middle Name:LEIGH
Last Name:WELLFORD
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 1:202 ARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2163
Mailing Address - Country:US
Mailing Address - Phone:262-844-9736
Mailing Address - Fax:
Practice Address - Street 1:346 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2664
Practice Address - Country:US
Practice Address - Phone:406-862-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003241152W00000X
MT5295152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist