Provider Demographics
NPI:1720042500
Name:WEIDIG, CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:WEIDIG
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:PO BOX 75
Mailing Address - Street 2:952 PENLLYN PIKE
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-0075
Mailing Address - Country:US
Mailing Address - Phone:215-628-8799
Mailing Address - Fax:215-628-8798
Practice Address - Street 1:952 PENLLYN PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-0000
Practice Address - Country:US
Practice Address - Phone:215-628-8799
Practice Address - Fax:215-628-8798
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG00550152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1639654OtherBCBS ID
PA2325746000OtherKEYSTONE ID
PA2325746000OtherKEYSTONE ID
PAT27158Medicare UPIN