1063602928 NPI number — DR. CORRIE DANIELLE WEITZEL O.D., M.S.

Table of content: DR. CORRIE DANIELLE WEITZEL O.D., M.S. (NPI 1063602928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063602928 NPI number — DR. CORRIE DANIELLE WEITZEL O.D., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEITZEL
Provider First Name:
CORRIE
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D., M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1063602928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 CHESTNUT COMMONS DR
Provider Second Line Business Mailing Address:
FAMILY HEALTH AND SURGERY CENTER
Provider Business Mailing Address City Name:
ELYRIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44035-9607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-366-9444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 CHESTNUT COMMONS DR
Provider Second Line Business Practice Location Address:
FAMILY HEALTH AND SURGERY CENTER
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-9607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-366-9444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5754 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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