Provider Demographics
NPI:1396392361
Name:WEIMER, AMBER (OD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WEIMER
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 1:2405 WILLOW TREE GRV APT 303
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-7127
Mailing Address - Country:US
Mailing Address - Phone:971-998-6050
Mailing Address - Fax:
Practice Address - Street 1:101 SUNDIAL DR
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-7769
Practice Address - Country:US
Practice Address - Phone:719-687-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist