Provider Demographics
NPI:1306861588
Name:WEITZ, DAVID A (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:WEITZ
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 1:720 SE MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5720
Mailing Address - Country:US
Mailing Address - Phone:919-467-0959
Mailing Address - Fax:919-467-5939
Practice Address - Street 1:720 SE MAYNARD RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5720
Practice Address - Country:US
Practice Address - Phone:919-467-0959
Practice Address - Fax:919-467-5939
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1608152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0994WOtherBCBSNC PROVIDER ID
NC890994WMedicaid
NC2470124AMedicare PIN
NC890994WMedicaid