MEDICARE: WEISMANN EYE CENTER, PC

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	207W00000X	Ophthalmology Physician	01046205A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881995843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEISMANN EYE CENTER, PC

Provider Business Mailing Address
First Line	:	10220 WICKER AVE STE 2
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8400
Country	:	US
Telephone Number	:	219-365-3900
Fax Number	:	218-365-5874

Provider Business Practice Location Address
First Line	:	10220 WICKER AVE STE 2
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8400
Country	:	US
Telephone Number	:	219-365-3900
Fax Number	:	218-365-5874

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. GAIL G. WEISMANN
Credential	:
Telephone Number	:	219-462-0018

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	03/10/2014

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Directions to “WEISMANN EYE CENTER, PC ” Practice Location

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