Provider Demographics
NPI:1104942903
Name:WEISS, RICHARD (OPTHALMIC DISPENSER)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:OPTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 VENUS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7592
Mailing Address - Country:US
Mailing Address - Phone:718-494-6336
Mailing Address - Fax:
Practice Address - Street 1:2303 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2805
Practice Address - Country:US
Practice Address - Phone:718-646-5020
Practice Address - Fax:718-648-6393
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5348156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician