Individual
KENNETH WEYBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1086 ST GEORGE AVE, RAHWAY, NJ 07065-2644
(732) 388-7337
Mailing address
1086 ST GEORGE AVE, RAHWAY, NJ 07065-2644
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
27OA00372900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1960709
—
NJ
Enumeration date
10/20/2006
Last updated
07/08/2007
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