Provider Demographics
NPI:1962685214
Name:WEISS COSMETIC & LASER VISION MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:WEISS COSMETIC & LASER VISION MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-720-1400
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7830
Mailing Address - Country:US
Mailing Address - Phone:949-720-1400
Mailing Address - Fax:949-720-1457
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 403
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7830
Practice Address - Country:US
Practice Address - Phone:949-720-1400
Practice Address - Fax:949-720-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G51078A156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty