Individual
DR. MICHAEL LESLIE WEEDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3201 GAINES RD, CORINTH, MS 38834-8422
(662) 286-8860
(662) 286-3079
Mailing address
3201 GAINES RD, CORINTH, MS 38834-8422
(662) 286-8860
(662) 286-3079
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
581
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01507367
—
MS
05
—
0880084
—
MS
01
—
721344463A
BLUE CROSS/BLUE SHIELD
MS
Enumeration date
01/19/2006
Last updated
02/17/2011
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