Provider Demographics
NPI:1205838554
Name:WEISS, MELVIN R (OD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:R
Last Name:WEISS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 CONCORD RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4310
Mailing Address - Country:US
Mailing Address - Phone:770-435-4457
Mailing Address - Fax:770-435-4555
Practice Address - Street 1:1239 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4310
Practice Address - Country:US
Practice Address - Phone:770-435-4457
Practice Address - Fax:770-435-4555
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11461OtherOPTICARE
GA727825OtherBCBS
GA1066147OtherAMERIGROUP
GA331302OtherCIGNA
GA4239284OtherAETNA
GA00004925BMedicaid
GA2230037OtherUNITED HEALTHCARE
GA1066147OtherAMERIGROUP
GA00004925BMedicaid
GA55419654SAMedicare PIN