Healthcare Provider Details

I. General information

NPI: 1689847279
Provider Name (Legal Business Name): DEBORAH C WESTON OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 MARKET ST
WESTON FL
33326-3663
US

IV. Provider business mailing address

1673 MARKET ST
WESTON FL
33326-3663
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-0266
  • Fax: 954-384-0214
Mailing address:
  • Phone: 954-384-0266
  • Fax: 954-384-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number003315
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number003315
License Number StateFL

VIII. Authorized Official

Name: DR. DEBORAH C WESTON
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 954-384-0266