Provider Demographics
NPI:1518961325
Name:WEISS, DONALD L JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:WEISS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:110 MATHIS DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2000
Mailing Address - Country:US
Mailing Address - Phone:615-446-8089
Mailing Address - Fax:615-441-3135
Practice Address - Street 1:110 MATHIS DR
Practice Address - Street 2:SUITE 108
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2000
Practice Address - Country:US
Practice Address - Phone:615-446-8089
Practice Address - Fax:615-441-3135
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNOD1073152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0393090004OtherDMERC
TN3596233Medicare ID - Type Unspecified
TNT61298Medicare UPIN