Basic Information
| Provider Information | |||||||||
| NPI: | 1730692815 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEAVER EYE ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2791 S QUEEN ST | ||||||||
| Address2: | |||||||||
| City: | DALLASTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173139540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177414788 | ||||||||
| FaxNumber: | 7177479111 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 HIGHLANDS DR STE 180 | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175432800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176254600 | ||||||||
| FaxNumber: | 7176254676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2017 | ||||||||
| LastUpdateDate: | 11/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7177414788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.