Provider Demographics
NPI:1285747790
Name:WEININGER, JUSTIN M (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:WEININGER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3608
Mailing Address - Country:US
Mailing Address - Phone:954-432-5000
Mailing Address - Fax:954-432-5001
Practice Address - Street 1:2068 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3608
Practice Address - Country:US
Practice Address - Phone:954-432-5000
Practice Address - Fax:954-432-5001
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 602156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0845740001Medicare NSC