Healthcare Provider Details

I. General information

NPI: 1679096812
Provider Name (Legal Business Name): ZACHERY R WEINBERG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 WASHINGTON ST
CHAGRIN FALLS OH
44022-4453
US

IV. Provider business mailing address

28600 ORANGE MEADOW LN
CHAGRIN FALLS OH
44022-1452
US

V. Phone/Fax

Practice location:
  • Phone: 440-247-4920
  • Fax:
Mailing address:
  • Phone: 502-523-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2080DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2080DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: