Provider Demographics
NPI:1013909944
Name:WEIMER, WILLIAM R (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:WEIMER
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 1:3019 S PARK RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1772
Mailing Address - Country:US
Mailing Address - Phone:412-835-4334
Mailing Address - Fax:
Practice Address - Street 1:3019 S PARK RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1772
Practice Address - Country:US
Practice Address - Phone:412-835-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU09734Medicare UPIN
PA0336980001Medicare NSC
PA580001572Medicare PIN
PA289134Medicare PIN