Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | VUT005155-1 | NY |
NPI | 1003963190 |
---|---|
Provider Name | Jeffrey Weissman |
First Address | Henrietta, NY 14467-9322 |
Second Address | Henrietta, NY 14467-9322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 10/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100173CS | PREFERRED CARE (01) | NY |
5833511 | AETNA (01) | NY |
P010005155 | (05) | NY |
P010005155 | BLUE CHOICE (01) | NY |
P010005155 | BLUE CROSS (01) | NY |
P010005155 | EXCELLUS (01) | NY |
P010005155 | VIA HEALTH (01) | NY |
U06022 | (02) | NY |