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General NPI Number Information
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NPI Number | 1316163892
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Entity Type | Individual
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Provider Name | DANIEL RALPH WEAVER O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 1055 MCHENRY RD
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City | WHEELING
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State | IL
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Zip | 60090-2231
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Country | US
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Telephone | 847-215-2583
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Fax | 847-215-2584
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Provider Business Mailing Address
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Address Line | 7012 W BIRCHWOOD AVE
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City | NILES
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State | IL
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Zip | 60714-3716
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Country | US
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Telephone | 847-647-9490
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Fax | 484-303-9252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046-008142
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License Number State | IL
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