Provider Demographics
NPI:1003963190
Name:WEISSMAN, JEFFREY (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9322
Mailing Address - Country:US
Mailing Address - Phone:585-334-7262
Mailing Address - Fax:
Practice Address - Street 1:2824 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9322
Practice Address - Country:US
Practice Address - Phone:585-334-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005155-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5833511OtherAETNA
NYP010005155OtherEXCELLUS
NYP010005155OtherVIA HEALTH
NYP010005155OtherBLUE CROSS
NY100173CSOtherPREFERRED CARE
NYP010005155Medicaid
NYP010005155OtherBLUE CHOICE
NY5833511OtherAETNA