Provider Demographics
NPI:1770609893
Name:WEINICK, RENAE ELAINA (OD)
Entity type:Individual
Prefix:DR
First Name:RENAE
Middle Name:ELAINA
Last Name:WEINICK
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:12260 ASBURY PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5504
Mailing Address - Country:US
Mailing Address - Phone:770-841-1616
Mailing Address - Fax:770-518-4882
Practice Address - Street 1:330 E CROSSVILLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3038
Practice Address - Country:US
Practice Address - Phone:770-518-4884
Practice Address - Fax:770-518-4882
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAGA1931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV01883Medicare UPIN