Healthcare Provider Details

I. General information

NPI: 1609032614
Provider Name (Legal Business Name): DR. KENNETH A. WEINBERG & ASSOC P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MOUNT MORIAH RD
MEMPHIS TN
38117-5705
US

IV. Provider business mailing address

826 MOUNT MORIAH RD
MEMPHIS TN
38117-5705
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-3232
  • Fax: 901-683-4463
Mailing address:
  • Phone: 901-683-3232
  • Fax: 901-683-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number749
License Number StateTN

VIII. Authorized Official

Name: DR. KENNETH A WEINBERG
Title or Position: PRESIDENT
Credential: O.D.
Phone: 901-683-3232