Provider Demographics
NPI:1184603003
Name:WEIGEL, JEN FANG LIU (OD)
Entity type:Individual
Prefix:DR
First Name:JEN
Middle Name:FANG LIU
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7930 JONES BRANCH DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3388
Mailing Address - Country:US
Mailing Address - Phone:703-556-9155
Mailing Address - Fax:
Practice Address - Street 1:7930 JONES BRANCH DR
Practice Address - Street 2:SUITE 250
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3388
Practice Address - Country:US
Practice Address - Phone:703-556-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist