Healthcare Provider Details

I. General information

NPI: 1619933280
Provider Name (Legal Business Name): SAMUEL L. WEIR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 WATERLOO RD
WARRENTON VA
20186-3011
US

IV. Provider business mailing address

5844 UNIVERSITY CT
WARRENTON VA
20187-9329
US

V. Phone/Fax

Practice location:
  • Phone: 540-347-0555
  • Fax: 540-347-9198
Mailing address:
  • Phone: 540-347-0555
  • Fax: 540-347-9198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000249
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: