MEDICARE: DR. MELVIN R. WEISS 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	740	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11461	OTHER	GA	OPTICARE
2	727825	OTHER	GA	BCBS
3	1066147	OTHER	GA	AMERIGROUP
4	331302	OTHER	GA	CIGNA
5	4239284	OTHER	GA	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	2230037	OTHER	GA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1205838554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVIN R. WEISS O.D.

Provider Business Mailing Address
First Line	:	1239 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4310
Country	:	US
Telephone Number	:	770-435-4457
Fax Number	:	770-435-4555

Provider Business Practice Location Address
First Line	:	1239 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4310
Country	:	US
Telephone Number	:	770-435-4457
Fax Number	:	770-435-4555

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/03/2008

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