Provider Demographics
NPI:1588650105
Name:WEIDEMA, FRANK LINSDAY (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:LINSDAY
Last Name:WEIDEMA
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 1:1518 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1518 MARKET ST
Practice Address - Street 2:
Practice Address - City:POCOMOKE
Practice Address - State:MD
Practice Address - Zip Code:21851-1712
Practice Address - Country:US
Practice Address - Phone:410-957-1113
Practice Address - Fax:410-957-4794
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002N831FMedicare PIN
MDT31245Medicare UPIN
MD0147590001Medicare NSC