Provider Demographics
NPI:1902862717
Name:WEISS EYE CARE CLINIC
Entity Type:Organization
Organization Name:WEISS EYE CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-882-0808
Mailing Address - Street 1:1300 19TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6799
Mailing Address - Country:US
Mailing Address - Phone:605-882-0808
Mailing Address - Fax:605-882-7078
Practice Address - Street 1:1300 19TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-6799
Practice Address - Country:US
Practice Address - Phone:605-882-0808
Practice Address - Fax:605-882-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSDT555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201302Medicaid
SD9213913OtherDAKOTA CARE
SD0040755OtherWELLMARK BCBS
SD4821160001Medicare NSC
SD9213913OtherDAKOTA CARE