Provider Demographics
NPI:1497817688
Name:WEINSTOCK, RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:WEINSTOCK
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 1:447 FULTON ST
Mailing Address - Street 2:SIGHT N STYLE OPTICAL
Mailing Address - City:BKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-855-0300
Mailing Address - Fax:718-855-2458
Practice Address - Street 1:447 FULTON ST
Practice Address - Street 2:SIGHT N STYLE OPTICAL
Practice Address - City:BKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-855-0300
Practice Address - Fax:718-855-2458
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00492168Medicaid
NY919580OtherBLCOK VISION