Provider Demographics
NPI:1679523864
Name:WEISKOPF, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:WEISKOPF
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 1:110 S FLAGLER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-3379
Mailing Address - Country:US
Mailing Address - Phone:561-582-8388
Mailing Address - Fax:
Practice Address - Street 1:901 N CONGRESS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3316
Practice Address - Country:US
Practice Address - Phone:561-732-8005
Practice Address - Fax:561-732-0150
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19423Medicare ID - Type Unspecified
FLT84237Medicare UPIN