Provider Demographics
NPI:1437417771
Name:BRENT H WEINMAN
Entity Type:Organization
Organization Name:BRENT H WEINMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-834-0707
Mailing Address - Street 1:183 E STATE ROAD 436
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2101
Mailing Address - Country:US
Mailing Address - Phone:407-834-0707
Mailing Address - Fax:407-834-0474
Practice Address - Street 1:183 E STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2101
Practice Address - Country:US
Practice Address - Phone:407-834-0707
Practice Address - Fax:407-834-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084204400Medicaid
FL19788Medicare PIN
FLT93807Medicare UPIN
FL084204400Medicaid