Provider Demographics
NPI:1649520263
Name:DANIEL T. WEIDENTHAL MD INC
Entity type:Organization
Organization Name:DANIEL T. WEIDENTHAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEIDENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-464-5266
Mailing Address - Street 1:25700 SCIENCE PARK DRIVE
Mailing Address - Street 2:SUITE #170
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7335
Mailing Address - Country:US
Mailing Address - Phone:216-464-5266
Mailing Address - Fax:216-464-5290
Practice Address - Street 1:25700 SCIENCE PARK DRIVE
Practice Address - Street 2:SUITE #170
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7335
Practice Address - Country:US
Practice Address - Phone:216-464-5266
Practice Address - Fax:216-464-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35023014207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty