Healthcare Provider Details

I. General information

NPI: 1962685214
Provider Name (Legal Business Name): WEISS COSMETIC & LASER VISION MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR SUITE 403
NEWPORT BEACH CA
92660-7830
US

IV. Provider business mailing address

360 SAN MIGUEL DR SUITE 403
NEWPORT BEACH CA
92660-7830
US

V. Phone/Fax

Practice location:
  • Phone: 949-720-1400
  • Fax: 949-720-1457
Mailing address:
  • Phone: 949-720-1400
  • Fax: 949-720-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberG51078A
License Number State

VIII. Authorized Official

Name: DR. RICHARD ALAN WEISS
Title or Position: DOCTOR
Credential: MD
Phone: 949-720-1400