Provider Demographics
NPI:1477525939
Name:WEBER, PATRICK MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MARTIN
Last Name:WEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:110 EXTON SQUARE MALL
Mailing Address - Street 2:STORE 1405
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2440
Mailing Address - Country:US
Mailing Address - Phone:484-875-9850
Mailing Address - Fax:484-534-8218
Practice Address - Street 1:110 EXTON SQUARE MALL
Practice Address - Street 2:STORE 1405
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2440
Practice Address - Country:US
Practice Address - Phone:484-875-9850
Practice Address - Fax:484-534-8218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA577298OtherCLARITY VISION
57764OtherAETNA US HEALTHCARE
PA577298OtherCLARITY VISION
57764OtherAETNA US HEALTHCARE