Healthcare Provider Details

I. General information

NPI: 1386638997
Provider Name (Legal Business Name): CURTIS WEAVER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 DANADA SQ W
WHEATON IL
60189-2041
US

IV. Provider business mailing address

241 W 17TH ST
LOMBARD IL
60148-6138
US

V. Phone/Fax

Practice location:
  • Phone: 630-752-0595
  • Fax: 630-752-0145
Mailing address:
  • Phone: 630-916-7992
  • Fax: 630-752-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-007064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: