Provider Demographics
NPI:1801888946
Name:WEINBERG, DANIEL L (OD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:WEINBERG
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 1:4949 BROWNSBORO RD # 271
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6424
Mailing Address - Country:US
Mailing Address - Phone:502-552-0967
Mailing Address - Fax:
Practice Address - Street 1:4414 SHELBYVILLE ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-894-4434
Practice Address - Fax:502-894-9912
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1049DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77021798Medicaid
IN100020520AMedicaid
KY582015048OtherEIN
T54724Medicare UPIN
IN100020520AMedicaid