Healthcare Provider Details

I. General information

NPI: 1679742167
Provider Name (Legal Business Name): WEISMAN EYE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MAPLE AVE SW
ROANOKE VA
24016-4707
US

IV. Provider business mailing address

1225 MAPLE AVE SW
ROANOKE VA
24016-4707
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-2020
  • Fax: 540-344-0079
Mailing address:
  • Phone: 540-345-2020
  • Fax: 540-344-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101048960
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number0101048960
License Number StateVA

VIII. Authorized Official

Name: JOSEPH S WEISMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 540-345-2020