Provider Demographics
NPI:1063465300
Name:WEITZEL, EILEEN M (OD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3740 S MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6700
Mailing Address - Country:US
Mailing Address - Phone:252-754-2020
Mailing Address - Fax:252-493-0100
Practice Address - Street 1:116 REGENCY BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4644
Practice Address - Country:US
Practice Address - Phone:252-754-2020
Practice Address - Fax:252-493-0100
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85921OtherMEDCOST PIN
NC0915FOtherBCBS OF NC
NC562118060OtherTRICARE PIN
NC890915FMedicaid
NC890915FMedicaid
NC85921OtherMEDCOST PIN