Provider Demographics
NPI:1225338619
Name:PATRICK M WEBER,O.D.
Entity Type:Organization
Organization Name:PATRICK M WEBER,O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:484-875-9850
Mailing Address - Street 1:110 EXTON SQUARE MALL
Mailing Address - Street 2:#1405
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2440
Mailing Address - Country:US
Mailing Address - Phone:484-875-9850
Mailing Address - Fax:186-658-7161
Practice Address - Street 1:110 EXTON SQUARE MALL
Practice Address - Street 2:#1405
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2440
Practice Address - Country:US
Practice Address - Phone:484-875-9850
Practice Address - Fax:186-658-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001755152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6962OtherEYE MED
0398924000OtherINDEPENDENCE BLUE CROSS
57764OtherAETNA
PA6962OtherEYE MED
0398924000OtherINDEPENDENCE BLUE CROSS