Provider Demographics
NPI:1699848796
Name:WEIL, SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WEIL
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 1:36 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2919
Mailing Address - Country:US
Mailing Address - Phone:516-883-8388
Mailing Address - Fax:516-883-8394
Practice Address - Street 1:36 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2919
Practice Address - Country:US
Practice Address - Phone:516-883-8388
Practice Address - Fax:516-883-8394
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003717-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00416257Medicaid
NYT81480Medicare UPIN
NY00416257Medicaid