Provider Demographics
NPI:1821010976
Name:WEISS, IRWIN STUART (MD)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:STUART
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 SORRENTO DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2746
Mailing Address - Country:US
Mailing Address - Phone:310-454-1490
Mailing Address - Fax:
Practice Address - Street 1:1521 SORRENTO DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2746
Practice Address - Country:US
Practice Address - Phone:310-454-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G151110OtherMEDICAL PPIN #
CAA39440Medicare UPIN
CAWG15111AMedicare ID - Type UnspecifiedPPIN #
CAWG15111DMedicare ID - Type UnspecifiedPPIN #