Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1593 | NC |
NPI | 1013052596 |
---|---|
Provider Name | Dr. Carrie Weaver |
First Address | Winston Salem, NC 27127-5655 |
Second Address | Walkertown, NC 27051-9529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 24/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0996B | BLUECROSS (01) | NC |
890996B | (05) | NC |
U58768 | (02) | NC |