Healthcare Provider Details

I. General information

NPI: 1033513981
Provider Name (Legal Business Name): WEINER EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER POINTE PKWY
CANTON GA
30114-2865
US

IV. Provider business mailing address

800 MOUNT VERNON HWY NE STE 120
ATLANTA GA
30328-4293
US

V. Phone/Fax

Practice location:
  • Phone: 770-720-4041
  • Fax:
Mailing address:
  • Phone: 770-804-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number033748
License Number StateGA

VIII. Authorized Official

Name: MARK J WEINER
Title or Position: SOLE MEMBER
Credential:
Phone: 770-720-4041