Provider Demographics
NPI:1215902721
Name:WEIL, JOHN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:WEIL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:MICHAEL
Other - Last Name:WEIL, P.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4554 VIRGINIA BEACH BLVD
Mailing Address - Street 2:STE 660
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3045
Mailing Address - Country:US
Mailing Address - Phone:757-497-1724
Mailing Address - Fax:757-499-2227
Practice Address - Street 1:549 E. BRAMBLETON AVE
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL NORFOLK, LLC
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:757-533-9441
Practice Address - Fax:757-446-1454
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9235311Medicaid
VA9235311Medicaid
VA410001324Medicare ID - Type Unspecified