=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043528060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON LYNN WEYAND O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2010
-----------------------------------------------------
Last Update Date | 08/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 LOWER SHILOH WAY STE 105
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-5431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-472-4070
-----------------------------------------------------
Fax | 919-472-4069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1004 LOWER SHILOH WAY STE 105
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-5431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-472-4070
-----------------------------------------------------
Fax | 919-472-4069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2216
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------