Dr. Amanda Weitzen, O.D. ,LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 4248 Issued in FL

Legal business name

DR. AMANDA WEITZEN, O.D. ,LLC

Practice address

4131 Southside Blvd
Ste 201
Jacksonville, FL 32216-5478

Phone

(904) 997-2018

Fax

(904) 997-2033

NPI assigned

Mar 21, 2010

Organization subpart

No

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

Authorized official

Name

Amanda Beth Weitzen, O.D.

Title

Owner

Phone

(904) 997-2018

Specialties & licenses 1

Addresses

Other names 1

• Dr. Amanda Weitzen Doing business as

Locations

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

{
    "created_epoch": "1269129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269129600000",
    "number": "1366766255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 SOUTHSIDE BLVD",
            "address_2": "STE 201",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165478",
            "telephone_number": "904-997-2018",
            "fax_number": "904-997-2033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 SOUTHSIDE BLVD",
            "address_2": "STE 201",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165478",
            "telephone_number": "904-997-2018",
            "fax_number": "904-997-2033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. AMANDA WEITZEN, O.D. ,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-21",
        "last_updated": "2010-03-21",
        "status": "A",
        "authorized_official_last_name": "WEITZEN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-997-2018",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Amanda Weitzen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2010; 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.