Individual provider Active NPI

Barry M Weiner, O.D.

  • Optometrist
  • Phoenix, MD
National Provider Identifier
1023099223
Registry record updated Dec 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA0595 Issued in MD
Practice address
3421 Sweet Air Rd
Phoenix, MD 21131-1812
Phone
(410) 628-1510
Fax
(410) 666-5244
NPI assigned
Nov 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA0595 MD Primary

Addresses

Primary practice location

3421 Sweet Air Rd
Phoenix, MD 21131-1812

Mailing address

3421 Sweet Air Rd
Phoenix, MD 21131-1812
Phone (410) 628-1510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TA0595MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
M. F. Diffendall OD PA Optometrist CurrentSince Dec 29, 2012 Accepting new patients
Jacksonville Eye Care Optometrist Past Accepting new patients

Locations

3332 Paper Mill Rd
Phoenix, MD 21131
Phone (410) 628-1510

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228348800000",
    "number": "1023099223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 SWEET AIR RD",
            "city": "PHOENIX",
            "state": "MD",
            "postal_code": "211311812",
            "telephone_number": "410-628-1510",
            "fax_number": "410-666-5244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 SWEET AIR RD",
            "city": "PHOENIX",
            "state": "MD",
            "postal_code": "211311812",
            "telephone_number": "410-628-1510",
            "fax_number": "410-666-5244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINER",
        "first_name": "BARRY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2008-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA0595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.