MEDICARE: STEVEN WEISBOND O.D.

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	OPC 1704	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457390148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WEISBOND O.D.

Provider Business Mailing Address
First Line	:	12910 LAZY PINE PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-4549
Country	:	US
Telephone Number	:	813-968-3134
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 W HILLSBOROUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-5653
Country	:	US
Telephone Number	:	813-870-2273
Fax Number	:	813-872-6486

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/09/2007

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