Healthcare Provider Details

I. General information

NPI: 1912963778
Provider Name (Legal Business Name): WILLIAM M WEILER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

IV. Provider business mailing address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4000
  • Fax: 608-824-4932
Mailing address:
  • Phone: 608-824-4000
  • Fax: 608-824-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1705-035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: