Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT002773 | GA |
NPI | 1013349745 |
---|---|
Provider Name | Dr. Anthony Arthur Weaver |
First Address | Vienna, VA 22182-3990 |
Second Address | Kingsland, GA 31548-6767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2013 |
Last Update Date | 16/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OPT002773 | STATE LICENSE (01) | GA |