Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1794 | KS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1794 | KS |
N | 152WP0200X | Pediatric Optomitrist | 1794 | KS |
NPI | 1225220346 |
---|---|
Provider Name | Dr. Justin Everett Weigel |
First Address | Olathe, KS 66061-9434 |
Second Address | Olathe, KS 66061-9434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 28/01/2015 |