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General NPI Number Information
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NPI Number | 1205169125
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Entity Type | Organization
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Legal Business Name | JENNIFER L WEAVER O.D., LLC
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 8425 PULSAR PL SUITE 240
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City | COLUMBUS
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State | OH
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Zip | 43240-2079
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Country | US
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Telephone | 614-885-9355
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Fax | 614-885-9359
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Provider Business Mailing Address
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Address Line | 8425 PULSAR PL SUITE 240
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City | COLUMBUS
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State | OH
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Zip | 43240-2079
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Country | US
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Telephone | 614-885-9355
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Fax | 614-885-9359
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JENNIFER L WEAVER
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Credential | O.D.
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Telephone | 614-313-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5438
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License Number State | OH
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