1225338619 NPI number — PATRICK M WEBER,O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225338619 NPI number — PATRICK M WEBER,O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK M WEBER,O.D.
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:
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:
1225338619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 EXTON SQUARE MALL
Provider Second Line Business Mailing Address:
#1405
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-875-9850
Provider Business Mailing Address Fax Number:
186-658-7161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 EXTON SQUARE MALL
Provider Second Line Business Practice Location Address:
#1405
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-875-9850
Provider Business Practice Location Address Fax Number:
186-658-7161
Provider Enumeration Date:
11/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
484-875-9850

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  OEG001755 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA6962 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0398924000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57764 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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