Provider Demographics
NPI:1124060629
Name:WESTON, MARION D (OD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:D
Last Name:WESTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1531 W 32ND ST
Mailing Address - Street 2:STE 102
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1611
Mailing Address - Country:US
Mailing Address - Phone:417-781-3630
Mailing Address - Fax:417-624-9704
Practice Address - Street 1:104 W SPRING ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1720
Practice Address - Country:US
Practice Address - Phone:417-451-0400
Practice Address - Fax:417-781-9814
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOT02157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202889648Medicaid
MO111979OtherBC/BS
MO310414107Medicaid
MO000091110Medicare PIN
T42664Medicare UPIN