Provider Demographics
NPI:1508913500
Name:WEINTRAUB, JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:WEINTRAUB
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 1:30 MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8427
Mailing Address - Country:US
Mailing Address - Phone:802-658-7610
Mailing Address - Fax:802-864-0893
Practice Address - Street 1:30 MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8427
Practice Address - Country:US
Practice Address - Phone:802-658-7610
Practice Address - Fax:802-864-0893
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTU46145Medicare UPIN
VTVN273301Medicare PIN