Basic Information
| Provider Information | |||||||||
| NPI: | 1174188890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEINSTEIN | ||||||||
| FirstName: | VICTOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11605 N LAMAR BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787532658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7372226996 | ||||||||
| FaxNumber: | 5125228836 | ||||||||
| Practice Location | |||||||||
| Address1: | 2970 HEMPSTEAD TPKE | ||||||||
| Address2: | |||||||||
| City: | LEVITTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117561343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166886052 | ||||||||
| FaxNumber: | 5165202044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2019 | ||||||||
| LastUpdateDate: | 05/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 004706 | NY | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.