Provider Demographics
NPI:1164561908
Name:DOUGLAS R. WEBERLING O.D. PC
Entity Type:Organization
Organization Name:DOUGLAS R. WEBERLING O.D. PC
Other - Org Name:WEBERLING & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WEBERLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:276-466-4227
Mailing Address - Street 1:1701 EUCLID AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3700
Mailing Address - Country:US
Mailing Address - Phone:276-466-4227
Mailing Address - Fax:
Practice Address - Street 1:1701 EUCLID AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3700
Practice Address - Country:US
Practice Address - Phone:276-466-4227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009203711Medicaid
VAT21597Medicare UPIN
C01540Medicare PIN
VA410000327Medicare ID - Type Unspecified
VA0773830002Medicare NSC