Provider Demographics
NPI:1659317865
Name:WEILAND, ROBERT A
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:WEILAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849
Mailing Address - Country:US
Mailing Address - Phone:641-743-6222
Mailing Address - Fax:641-743-8261
Practice Address - Street 1:107 NE 2ND STREET
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849
Practice Address - Country:US
Practice Address - Phone:641-743-6222
Practice Address - Fax:641-743-8261
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1605T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0124958Medicaid
IA12495Medicare PIN
IAT00788Medicare UPIN
IA0221080001Medicare NSC