MEDICARE: DR. AMANDA WEISS OD

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	OPC4077	FL

General Provider Information

NPI Number	:	1356480313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA WEISS OD

Provider Business Mailing Address
First Line	:	2545 S STATE ROAD 7
Second Line	:	# 10
City	:	WELLINGTON
State	:	FL
Zip	:	33414-9323
Country	:	US
Telephone Number	:	561-876-5385
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 S STATE ROAD 7
Second Line	:	#10
City	:	WELLINGTON
State	:	FL
Zip	:	33414-9323
Country	:	US
Telephone Number	:	561-876-5385
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	06/30/2016

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