Healthcare Provider Details

I. General information

NPI: 1265419881
Provider Name (Legal Business Name): RICHARD D WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E DAY RD 100
MISHAWAKA IN
46545-3408
US

IV. Provider business mailing address

230 E DAY RD 100
MISHAWAKA IN
46545-3408
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-3939
  • Fax: 574-271-3941
Mailing address:
  • Phone: 574-271-3939
  • Fax: 574-271-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01027188A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: