Active NPI
Maryjane Weil, O.D.
- Optometrist
- Fort Collins, CO
National Provider Identifier
1053581421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2460
- Practice address
- 1625 Ticonderoga Dr
Fort Collins, CO 80525-3454 - Phone
- (970) 377-1090
- Fax
- (970) 493-9309
- NPI assigned
- Mar 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2460 | CO | Primary |
Addresses
Primary practice location
1625 Ticonderoga Dr
Fort Collins, CO 80525-3454
Mailing address
1625 Ticonderoga Dr
Fort Collins, CO 80525-3454
Phone (970) 377-1090
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 804282 | Other | MEDICARE # | |
| 486668 | Other | MEDICARE GROUP |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2460 | CO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204416000000",
"number": "1053581421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 TICONDEROGA DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805253454",
"telephone_number": "970-377-1090",
"fax_number": "970-493-9309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 TICONDEROGA DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805253454",
"telephone_number": "970-377-1090",
"fax_number": "970-493-9309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEIL",
"first_name": "MARYJANE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-02",
"last_updated": "2008-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CO",
"license": "2460",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE #",
"identifier": "804282",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "486668",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.