Provider Demographics
NPI:1396833182
Name:WEISS, HOWARD J (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
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 1:10605 BALBOA BLVD
Mailing Address - Street 2:SIUTE 230
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6342
Mailing Address - Country:US
Mailing Address - Phone:818-368-4114
Mailing Address - Fax:818-366-2024
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:SIUTE 230
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-368-4114
Practice Address - Fax:818-366-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5968T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy