Provider Demographics
NPI:1710036702
Name:WEIBERT, JULIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:M
Last Name:WEIBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:54 MONUMENT CIRCLE
Practice Address - Street 2:STE 125
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:317-631-1200
Practice Address - Fax:317-631-1600
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009765152W00000X
IL346002316152W00000X
KS1726152W00000X
CA12871152W00000X
IN18003691A152W00000X
IN18003691B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400052547Medicare PIN
ILV06607Medicare UPIN