Provider Demographics
NPI:1942482096
Name:WEBER, ANTHONY R (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:WEBER
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 1:1301 W EVERGREEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1634
Mailing Address - Country:US
Mailing Address - Phone:217-342-3838
Mailing Address - Fax:217-342-3880
Practice Address - Street 1:1301 W EVERGREEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1634
Practice Address - Country:US
Practice Address - Phone:217-342-3838
Practice Address - Fax:217-342-3880
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.007949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0372510001Medicare NSC
ILP00467165Medicare PIN
IL762990Medicare PIN