Provider Demographics
NPI:1134571649
Name:WEISER, JAMIE (OD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WEISER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 STATE LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3447
Mailing Address - Country:US
Mailing Address - Phone:139-588-6605
Mailing Address - Fax:
Practice Address - Street 1:7400 STATE LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3447
Practice Address - Country:US
Practice Address - Phone:913-588-6600
Practice Address - Fax:913-588-6655
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020868152W00000X
WI3459152W00000X
KS2043152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics