Provider Demographics
NPI:1033513981
Name:WEINER EYE CENTER, LLC
Entity Type:Organization
Organization Name:WEINER EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-720-4041
Mailing Address - Street 1:1320 OAKSIDE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 OAKSIDE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2475
Practice Address - Country:US
Practice Address - Phone:770-720-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033748207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty