Healthcare Provider Details

I. General information

NPI: 1154633253
Provider Name (Legal Business Name): WEIS EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 W ARROWHEAD RD SUITE 120
HERMANTOWN MN
55811-4004
US

IV. Provider business mailing address

4815 W ARROWHEAD RD SUITE 120
HERMANTOWN MN
55811-4004
US

V. Phone/Fax

Practice location:
  • Phone: 218-625-1917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number42784
License Number StateMN

VIII. Authorized Official

Name: JEFFREY R WEIS
Title or Position: OWNER
Credential: M.D.
Phone: 218-625-1917