Provider Demographics
NPI:1255634952
Name:WEISS, AUDREY LEE (OD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LEE
Last Name:WEISS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2378 PRESIDIO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1022
Mailing Address - Country:US
Mailing Address - Phone:619-296-4135
Mailing Address - Fax:619-296-4130
Practice Address - Street 1:894 PALM AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-1572
Practice Address - Country:US
Practice Address - Phone:619-424-9333
Practice Address - Fax:619-424-3356
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-18
Last Update Date:2010-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACA6834T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist