Provider Demographics
NPI:1689797623
Name:SCOTT WEIL, O.D.,P.C.
Entity type:Organization
Organization Name:SCOTT WEIL, O.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-883-8388
Mailing Address - Street 1:36 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2919
Mailing Address - Country:US
Mailing Address - Phone:516-883-8388
Mailing Address - Fax:516-883-8394
Practice Address - Street 1:36 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2919
Practice Address - Country:US
Practice Address - Phone:516-883-8388
Practice Address - Fax:516-883-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0714710001Medicare NSC
NYC29678CC11Medicare PIN