Provider Demographics
NPI:1316120876
Name:BENNETT A WEINER, OD
Entity type:Organization
Organization Name:BENNETT A WEINER, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETRT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-697-3995
Mailing Address - Street 1:1447 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3614
Mailing Address - Country:US
Mailing Address - Phone:562-697-3995
Mailing Address - Fax:562-697-3446
Practice Address - Street 1:1447 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3614
Practice Address - Country:US
Practice Address - Phone:562-697-3995
Practice Address - Fax:562-697-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9119T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD001180Medicaid
T95614Medicare UPIN