MEDICARE: STEVEN J. WEAVER, O.D. LLC

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	328345-9934	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801927140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN J. WEAVER, O.D. LLC

Provider Business Mailing Address
First Line	:	11038 HIGHLAND BLVD
Second Line	:	#300
City	:	HIGHLAND
State	:	UT
Zip	:	84003-3785
Country	:	US
Telephone Number	:	801-756-7150
Fax Number	:	801-642-0938

Provider Business Practice Location Address
First Line	:	11038 HIGHLAND BLVD
Second Line	:	#300
City	:	HIGHLAND
State	:	UT
Zip	:	84003-3785
Country	:	US
Telephone Number	:	801-756-7150
Fax Number	:	801-642-0938

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	STEVEN J. WEAVER
Credential	:	O.D.
Telephone Number	:	802-756-7150

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/29/2009

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