=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851661649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARMAIN KAREN WEINBERG, OD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2012
-----------------------------------------------------
Last Update Date | 04/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14050 US HIGHWAY 1 SUITE E
-----------------------------------------------------
City | JUNO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33408-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-622-7220
-----------------------------------------------------
Fax | 561-622-7880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14050 US HIGHWAY 1 SUITE E
-----------------------------------------------------
City | JUNO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33408-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-622-7220
-----------------------------------------------------
Fax | 561-622-7880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | CHARMAIN KAREN WEINBERG
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 561-622-7220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3063
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------