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General NPI Number Information
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NPI Number | 1437417771
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Entity Type | Organization
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Legal Business Name | BRENT H WEINMAN
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 183 E STATE ROAD 436
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City | FERN PARK
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State | FL
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Zip | 32730-2101
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Country | US
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Telephone | 407-834-0707
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Fax | 407-834-0474
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Provider Business Mailing Address
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Address Line | 183 E STATE ROAD 436
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City | FERN PARK
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State | FL
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Zip | 32730-2101
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Country | US
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Telephone | 407-834-0707
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Fax | 407-834-0474
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT H WEINMAN
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Credential | O.D.
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Telephone | 407-834-0707
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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 | OPC904
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License Number State | FL
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