MEDICARE: KRISTI K WEATHERLY OD

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	152W00000X	Optometrist	OEG002892	PA

General Provider Information

NPI Number	:	1376983445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI K WEATHERLY OD

Provider Business Mailing Address
First Line	:	744 SHENANGO RD STE 1
Second Line	:
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-7111
Country	:	US
Telephone Number	:	724-846-2020
Fax Number	:	724-846-7287

Provider Business Practice Location Address
First Line	:	744 SHENANGO RD STE 1
Second Line	:
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-7111
Country	:	US
Telephone Number	:	724-846-2020
Fax Number	:	724-846-7287

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

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	08/06/2020

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