Provider Demographics
NPI:1851416903
Name:WEISMAN, WILLIAM W (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:WEISMAN
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 1:1718 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5241
Mailing Address - Country:US
Mailing Address - Phone:661-327-4888
Mailing Address - Fax:661-324-1115
Practice Address - Street 1:1718 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5241
Practice Address - Country:US
Practice Address - Phone:661-327-4888
Practice Address - Fax:661-324-1115
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT09650Medicare UPIN