Provider Demographics
NPI:1639223951
Name:WEBER, JOHN D (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:WEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-0160
Mailing Address - Country:US
Mailing Address - Phone:830-693-2020
Mailing Address - Fax:830-693-9318
Practice Address - Street 1:2006 US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4318
Practice Address - Country:US
Practice Address - Phone:830-693-2020
Practice Address - Fax:830-693-9318
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2360T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0669480001OtherPALMETTO (DURABLE MEDICAL
TX093237801Medicaid
TX410039577OtherRAILROAD MEDICARE
TX0669480001OtherPALMETTO (DURABLE MEDICAL
TXT16524Medicare UPIN
00E42KMedicare PIN