1598889289 NPI number — BRODSKY & WEIKUM, INC

Table of content: (NPI 1598889289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598889289 NPI number — BRODSKY & WEIKUM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRODSKY & WEIKUM, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. ROGER WEIKUM
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598889289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 ROSS AVE # 260LB4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75201-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-220-2425
Provider Business Mailing Address Fax Number:
214-220-2488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 ROSS AVE # 260LB4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75201-2739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-220-2425
Provider Business Practice Location Address Fax Number:
214-220-2488
Provider Enumeration Date:
03/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEIKUM
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
THERAPEUTIC OPTOMETRIST
Authorized Official Telephone Number:
214-220-2425

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  002243TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 002243TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)