Individual
DR. MYRA RENEE WEBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4626 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6897
(260) 432-5502
(260) 432-8415
Mailing address
4626 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6897
(260) 432-5502
(260) 432-8415
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003594A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00959074
PROVIDER PTAN
IN
Enumeration date
07/02/2009
Last updated
05/26/2022
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