Provider Demographics
NPI:1225220346
Name:WEIGEL, JUSTIN EVERETT (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:EVERETT
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:11148 S LONE ELM RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-9434
Mailing Address - Country:US
Mailing Address - Phone:913-390-6700
Mailing Address - Fax:913-390-6705
Practice Address - Street 1:11148 S LONE ELM RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9434
Practice Address - Country:US
Practice Address - Phone:913-390-6700
Practice Address - Fax:913-390-6705
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2015-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1794152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics