Provider Demographics
NPI:1346297264
Name:WEISS, JEFFREY ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
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 1:23007 U.S. 441
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5433
Mailing Address - Country:US
Mailing Address - Phone:561-482-0099
Mailing Address - Fax:561-482-0099
Practice Address - Street 1:23007 U.S. 441
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5433
Practice Address - Country:US
Practice Address - Phone:561-482-0099
Practice Address - Fax:561-482-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1129152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC69181Medicare UPIN
FL0581380001Medicare NSC
FL19217Medicare ID - Type Unspecified