Provider Demographics
NPI:1023035607
Name:WEISS, RICHARD G (OPTICIAN/TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:WEISS
Suffix:
Gender:M
Credentials:OPTICIAN/TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2915 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9501
Practice Address - Country:US
Practice Address - Phone:717-755-1993
Practice Address - Fax:717-751-0898
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANOT APPLICABLE IN PA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician