Provider Demographics
NPI:1154012847
Name:WEINSTOCK, VIVIAN RADA (DO)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:RADA
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMLIN CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-7211
Mailing Address - Country:US
Mailing Address - Phone:321-947-7172
Mailing Address - Fax:
Practice Address - Street 1:14821 SIX MILE CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4467
Practice Address - Country:US
Practice Address - Phone:239-437-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician