Provider Demographics
NPI:1609032614
Name:DR. KENNETH A. WEINBERG & ASSOC P.A.
Entity Type:Organization
Organization Name:DR. KENNETH A. WEINBERG & ASSOC P.A.
Other - Org Name:DR. KENNETH A. WEINBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-683-3232
Mailing Address - Street 1:826 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5705
Mailing Address - Country:US
Mailing Address - Phone:901-683-3232
Mailing Address - Fax:901-683-4463
Practice Address - Street 1:826 MOUNT MORIAH RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5705
Practice Address - Country:US
Practice Address - Phone:901-683-3232
Practice Address - Fax:901-683-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN749152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3597880Medicare PIN