Healthcare Provider Details

I. General information

NPI: 1669521753
Provider Name (Legal Business Name): DANIEL JOHN WEBER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 N 2ND ST
CLINTON MO
64735-1192
US

IV. Provider business mailing address

1602 N 2ND ST
CLINTON MO
64735-1192
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-8171
  • Fax: 660-890-8496
Mailing address:
  • Phone: 660-885-8171
  • Fax: 660-890-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2020034823
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: