Provider Demographics
NPI:1922188614
Name:WEEDEN, STEVEN LEE (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:WEEDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4355
Mailing Address - Country:US
Mailing Address - Phone:512-894-4392
Mailing Address - Fax:
Practice Address - Street 1:605 W CREEK DR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4355
Practice Address - Country:US
Practice Address - Phone:512-894-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4408TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88V8400Medicaid
TX88V840Medicare ID - Type Unspecified
TX88V8400Medicaid