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General NPI Number Information
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NPI Number | 1689779712
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Entity Type | Individual
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Provider Name | JEFFREY LANCE WEAVER O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 1200 W GODFREY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3323
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Country | US
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Telephone | 215-276-6000
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Fax | 215-276-1329
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Provider Business Mailing Address
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Address Line | 3662 BOSTONS FARM DR
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City | BRIDGETON
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State | MO
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Zip | 63044-3167
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Country | US
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Telephone | 314-952-2226
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Fax | 314-228-2020
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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 | 4248T125
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG003775
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T02793
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2042
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License Number State | OR
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