MEDICARE: DAVID M WEISSMAN OPHTHALMIC DISPENSER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	008565-1	NY

General Provider Information

NPI Number	:	1194853184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M WEISSMAN OPHTHALMIC DISPENSER

Provider Business Mailing Address
First Line	:	2770 OCEAN AVE
Second Line	:	2H
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4748
Country	:	US
Telephone Number	:	646-644-4641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3201
Country	:	US
Telephone Number	:	718-332-1017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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