Provider Demographics
NPI:1407873326
Name:SIDNEY JAY WEISS, M.D. INC
Entity Type:Organization
Organization Name:SIDNEY JAY WEISS, M.D. INC
Other - Org Name:SADDLEBACK EYE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-0225
Mailing Address - Street 1:26691 PLAZA
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6398
Mailing Address - Country:US
Mailing Address - Phone:949-364-0225
Mailing Address - Fax:949-364-9014
Practice Address - Street 1:26691 PLAZA
Practice Address - Street 2:SUITE 250
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6398
Practice Address - Country:US
Practice Address - Phone:949-364-0225
Practice Address - Fax:949-364-9014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIDNEY JAY WEISS, M.D. INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-16
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00295ZOtherBLUE SHIELD
CA=========OtherBLUE CROSS
CA1077870001Medicare NSC
W15104Medicare ID - Type Unspecified