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General NPI Number Information
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NPI Number | 1679742167
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Entity Type | Organization
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Legal Business Name | WEISMAN EYE CLINIC LLC
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 1225 MAPLE AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4707
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Country | US
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Telephone | 540-345-2020
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Fax | 540-344-0079
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Provider Business Mailing Address
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Address Line | 1225 MAPLE AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4707
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Country | US
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Telephone | 540-345-2020
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Fax | 540-344-0079
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH S WEISMAN
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Credential | MD
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Telephone | 540-345-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101048960
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number | 0101048960
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License Number State | VA
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