Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT5478 | CA |
NPI | 1003838178 |
---|---|
Provider Name | Barry A Weissman |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-7065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 28/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0054780 | (05) | CA |
U37994 | (02) | CA |