Provider Demographics
NPI:1265504658
Name:WEISS, BENJAMIN P (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:P
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 1:2046 TREASURE COAST PLZ STE A
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0931
Mailing Address - Country:US
Mailing Address - Phone:772-205-0120
Mailing Address - Fax:
Practice Address - Street 1:530 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5450
Practice Address - Country:US
Practice Address - Phone:772-562-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621272700Medicaid
FL621272700Medicaid
FL39740Medicare PIN