Provider Demographics
NPI:1073696431
Name:WEISZ, YVONNE K (OD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:K
Last Name:WEISZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11398 KENYON WAY STE C
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9229
Mailing Address - Country:US
Mailing Address - Phone:909-477-3211
Mailing Address - Fax:909-477-3213
Practice Address - Street 1:11398 KENYON WAY STE C
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-9229
Practice Address - Country:US
Practice Address - Phone:909-477-3211
Practice Address - Fax:909-477-3213
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10441T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU94474Medicare UPIN