Provider Demographics
NPI:1790881076
Name:WEITZEL & ASSOCIATES PA
Entity Type:Organization
Organization Name:WEITZEL & ASSOCIATES PA
Other - Org Name:20 20 VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-754-2020
Mailing Address - Street 1:116 REGENCY BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4644
Mailing Address - Country:US
Mailing Address - Phone:252-754-2020
Mailing Address - Fax:252-493-0100
Practice Address - Street 1:116 REGENCY BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4644
Practice Address - Country:US
Practice Address - Phone:252-754-2020
Practice Address - Fax:252-493-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0915FOtherBCBS GROUP 01060
NC890915FMedicaid
0915FOtherBCBS GROUP 01060
NC890915FMedicaid