MEDICARE: DR. HOWARD J 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	152WV0400X	Vision Therapy Optometrist	5968T	CA

General Provider Information

NPI Number	:	1396833182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD J WEISS O.D.

Provider Business Mailing Address
First Line	:	10605 BALBOA BLVD
Second Line	:	SIUTE 230
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6342
Country	:	US
Telephone Number	:	818-368-4114
Fax Number	:	818-366-2024

Provider Business Practice Location Address
First Line	:	10605 BALBOA BLVD
Second Line	:	SIUTE 230
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6342
Country	:	US
Telephone Number	:	818-368-4114
Fax Number	:	818-366-2024

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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