MEDICARE: STEVEN J WEAVER OD

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
1	152W00000X	Optometrist	3283459934	UT
2	152W00000X	Optometrist	3283458904	UT

General Provider Information

NPI Number	:	1487630588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN J WEAVER OD

Provider Business Mailing Address
First Line	:	11038 HIGHLAND BLVD STE 300
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-3788
Country	:	US
Telephone Number	:	801-756-7150
Fax Number	:	801-642-0938

Provider Business Practice Location Address
First Line	:	11038 HIGHLAND BLVD STE 300
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-3788
Country	:	US
Telephone Number	:	801-756-7150
Fax Number	:	801-642-0938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	08/25/2009

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Directions to “ STEVEN J WEAVER OD” Practice Location

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