Provider Demographics
NPI:1265002521
Name:WEAKLAND, EMILY (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WEAKLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:SANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1919 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1283
Practice Address - Country:US
Practice Address - Phone:308-382-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist