MEDICARE: DR. CHRISTIE ALTICE WEAVER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618001011	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	462613	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1801817317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIE ALTICE WEAVER O.D.

Provider Business Mailing Address
First Line	:	13995 U.S. HIGHWAY 29, SUITE 100
Second Line	:
City	:	CHATHAM
State	:	VA
Zip	:	24531
Country	:	US
Telephone Number	:	434-432-9752
Fax Number	:	434-432-8580

Provider Business Practice Location Address
First Line	:	CHATHAM FAMILY EYECARE CENTER
Second Line	:	13995 US HIGHWAY 29 SUITE 100
City	:	CHATHAM
State	:	VA
Zip	:	24531
Country	:	US
Telephone Number	:	434-432-9752
Fax Number	:	434-432-8580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CHRISTIE ALTICE WEAVER O.D.” Practice Location

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