MEDICARE: DR. BARRY M WEINER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA0595	MD

General Provider Information

NPI Number	:	1023099223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY M WEINER O.D.

Provider Business Mailing Address
First Line	:	3421 SWEET AIR RD
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-1812
Country	:	US
Telephone Number	:	410-628-1510
Fax Number	:	410-666-5244

Provider Business Practice Location Address
First Line	:	3421 SWEET AIR RD
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-1812
Country	:	US
Telephone Number	:	410-628-1510
Fax Number	:	410-666-5244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/04/2008

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