Provider Demographics
NPI:1295773521
Name:WEBER, BRIAN LLOYD (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LLOYD
Last Name:WEBER
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 1:1380 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4500
Mailing Address - Country:US
Mailing Address - Phone:352-683-2020
Mailing Address - Fax:352-683-3168
Practice Address - Street 1:1380 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4500
Practice Address - Country:US
Practice Address - Phone:352-683-2020
Practice Address - Fax:352-683-3168
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC 1451OtherCERTIFIED OPTOMETRIST
FL620170900Medicaid
FL620170900Medicaid
FLT93862Medicare UPIN
FLOPC 1451OtherCERTIFIED OPTOMETRIST