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General NPI Number Information
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NPI Number | 1346288339
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Entity Type | Organization
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Legal Business Name | JEROME WEITZEN OD PA
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 213 N LAURA ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3501
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Country | US
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Telephone | 904-353-3163
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Fax | 904-355-1813
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Provider Business Mailing Address
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Address Line | 213 N LAURA ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3501
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Country | US
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Telephone | 904-353-3163
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Fax | 904-355-1813
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Authorized Official
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Title or Position | PRES
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Name | DR. JEROME WEITZEN
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Credential | OD
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Telephone | 904-353-3163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 700
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License Number State | FL
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