Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2900TG | TX |
NPI | 1306880059 |
---|---|
Provider Name | Garth B Weaver |
First Address | Pflugerville, TX 78660-8304 |
Second Address | Austin, TX 78731-2994 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 13/09/2012 |