Provider Demographics
NPI:1356480313
Name:WEISS, AMANDA (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 S STATE ROAD 7
Mailing Address - Street 2:# 10
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9323
Mailing Address - Country:US
Mailing Address - Phone:561-876-5385
Mailing Address - Fax:
Practice Address - Street 1:2545 S STATE ROAD 7
Practice Address - Street 2:#10
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9323
Practice Address - Country:US
Practice Address - Phone:561-876-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist