Provider Demographics
NPI:1699091637
Name:MARK WEINBERGER OD
Entity type:Organization
Organization Name:MARK WEINBERGER OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEINBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-953-3636
Mailing Address - Street 1:2351 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122
Mailing Address - Country:US
Mailing Address - Phone:412-653-9700
Mailing Address - Fax:412-653-3964
Practice Address - Street 1:2351 CENTURY DR
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2430
Practice Address - Country:US
Practice Address - Phone:412-653-9700
Practice Address - Fax:412-653-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET-9049152W00000X
PAOEG-0503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102113605Medicaid
PA102113605Medicaid