Provider Demographics
NPI:1902967466
Name:WEISS, DOUGLAS FLOYD (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:FLOYD
Last Name:WEISS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTRE COURT
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-2329
Mailing Address - Country:US
Mailing Address - Phone:434-591-0262
Mailing Address - Fax:434-591-0111
Practice Address - Street 1:5 CENTRE COURT
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-2329
Practice Address - Country:US
Practice Address - Phone:434-591-0262
Practice Address - Fax:434-591-0111
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000628152W00000X
NYTUV0050411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA224432OtherANTHEM
VA9234292Medicaid
VA151998OtherSOUTHERN HEALTH
VA204999OtherANTHEM
VA9233202Medicaid
VA9234292Medicaid
VA151998OtherSOUTHERN HEALTH
VA224432OtherANTHEM