Provider Demographics
NPI:1316967433
Name:WEBER, MICHAEL J (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:WEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W. SCHROCK RD.
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8717
Mailing Address - Country:US
Mailing Address - Phone:614-891-0350
Mailing Address - Fax:614-891-0351
Practice Address - Street 1:555 W SCHROCK RD STE B
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8717
Practice Address - Country:US
Practice Address - Phone:614-891-0350
Practice Address - Fax:614-891-0351
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3384152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH875000001OtherDMERC
OH580002920OtherMEDICARE RR PIN
OH0875000001Medicare NSC
OHT47364Medicare UPIN
OH875000001OtherDMERC