MEDICARE: AMBER WEIMER 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	3505	CO

General Provider Information

NPI Number	:	1396392361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER WEIMER OD

Provider Business Mailing Address
First Line	:	2405 WILLOW TREE GRV APT 303
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-7127
Country	:	US
Telephone Number	:	971-998-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SUNDIAL DR
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-7769
Country	:	US
Telephone Number	:	719-687-3937
Fax Number	:

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

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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