MEDICARE: DR. DANIEL MARK WEIR 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	114417-9934	UT

General Provider Information

NPI Number	:	1578513727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL MARK WEIR O.D.

Provider Business Mailing Address
First Line	:	2290 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2831
Country	:	US
Telephone Number	:	801-261-8263
Fax Number	:	801-261-8263

Provider Business Practice Location Address
First Line	:	2290 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2831
Country	:	US
Telephone Number	:	801-261-8263
Fax Number	:	801-261-8263

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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