Provider Demographics
NPI:1184849002
Name:WEISS, DONNA CATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:CATHERINE
Last Name:WEISS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 BROXTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2803
Mailing Address - Country:US
Mailing Address - Phone:310-208-3011
Mailing Address - Fax:310-208-6831
Practice Address - Street 1:1069 BROXTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2803
Practice Address - Country:US
Practice Address - Phone:310-208-3011
Practice Address - Fax:310-208-6831
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006896-1152W00000X
CAOPT 13239 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP13239AMedicare PIN