Healthcare Provider Details

I. General information

NPI: 1306880059
Provider Name (Legal Business Name): GARTH B WEAVER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 FAR WEST BLVD
AUSTIN TX
78731-2994
US

IV. Provider business mailing address

2509 CRYSTAL BEND DR
PFLUGERVILLE TX
78660-8304
US

V. Phone/Fax

Practice location:
  • Phone: 512-343-0432
  • Fax:
Mailing address:
  • Phone: 512-252-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2900TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: