Provider Demographics
NPI:1992405427
Name:WEICKERT, TERRI (OPTICIAN)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:WEICKERT
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 E HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2611
Mailing Address - Country:US
Mailing Address - Phone:419-734-7995
Mailing Address - Fax:
Practice Address - Street 1:2826 E HARBOR RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2611
Practice Address - Country:US
Practice Address - Phone:419-734-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.011133-SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician