Provider Demographics
NPI:1346536109
Name:RICHARD A. WEISE, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD A. WEISE, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-956-1010
Mailing Address - Street 1:501 W GLENOAKS BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2896
Mailing Address - Country:US
Mailing Address - Phone:818-956-1010
Mailing Address - Fax:818-543-6083
Practice Address - Street 1:500 N CENTRAL AVE STE 400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1928
Practice Address - Country:US
Practice Address - Phone:818-956-1010
Practice Address - Fax:818-543-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty