Individual
DUSTIN MICHAEL WEIDERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2468 LOUISIANA AVE, LUTCHER, LA 70071-5411
(225) 869-5043
(225) 869-8400
Mailing address
550 CONNELL PARK LN, BATON ROUGE, LA 70806-6539
(225) 924-2020
(225) 924-2089
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1974-920AT
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1974-920AT
LA OD LICENSE
LA
Enumeration date
08/04/2022
Last updated
08/04/2022
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