Provider Demographics
NPI:1790819365
Name:WEISS, KATHLEEN FERRO (OPHTHAMIC DISPENSER)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FERRO
Last Name:WEISS
Suffix:
Gender:F
Credentials:OPHTHAMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5450
Practice Address - Country:US
Practice Address - Phone:607-754-8670
Practice Address - Fax:607-786-5318
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC0037771156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0131380001Medicare NSC