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General NPI Number Information
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NPI Number | 1801927140
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Entity Type | Organization
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Legal Business Name | STEVEN J. WEAVER, O.D. LLC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 11038 HIGHLAND BLVD #300
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City | HIGHLAND
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State | UT
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Zip | 84003-3785
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Country | US
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Telephone | 801-756-7150
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Fax | 801-642-0938
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Provider Business Mailing Address
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Address Line | 11038 HIGHLAND BLVD #300
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City | HIGHLAND
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State | UT
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Zip | 84003-3785
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Country | US
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Telephone | 801-756-7150
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Fax | 801-642-0938
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | STEVEN J. WEAVER
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Credential | O.D.
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Telephone | 802-756-7150
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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 | 328345-9934
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License Number State | UT
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