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NPI Code Detail

MEDICARE: DR. JENNIFER LEE WEAVER O.D.

MEDICARE: DR. JENNIFER LEE WEAVER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist5348OH

General Provider Information

NPI Number : 1336185172
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER LEE WEAVER O.D.
Provider Business Mailing Address
First Line : 4760 STONE VIEW CT
Second Line :
City : POWELL
State : OH
Zip : 43065-7966
Country : US
Telephone Number : 740-881-5373
Fax Number :
Provider Business Practice Location Address
First Line : 1150 POLARIS PKWY
Second Line :
City : COLUMBUS
State : OH
Zip : 43240-2024
Country : US
Telephone Number : 614-433-7357
Fax Number : 614-847-4138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 07/08/2007

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