Provider Demographics
NPI:1679903850
Name:WEBER OPTIKS INC.
Entity Type:Organization
Organization Name:WEBER OPTIKS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-342-3838
Mailing Address - Street 1:1301 W EVERGREEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1634
Mailing Address - Country:US
Mailing Address - Phone:217-342-3838
Mailing Address - Fax:217-342-3880
Practice Address - Street 1:1301 W EVERGREEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1634
Practice Address - Country:US
Practice Address - Phone:217-342-3838
Practice Address - Fax:217-342-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00467165Medicare PIN
0372510001Medicare NSC
IL762990Medicare PIN