Provider Demographics
NPI:1811313539
Name:DANIEL L WEINBERG OD PSC
Entity type:Organization
Organization Name:DANIEL L WEINBERG OD PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-552-0967
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 RD STE 204
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5328
Practice Address - Country:US
Practice Address - Phone:502-894-4434
Practice Address - Fax:502-894-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty