Individual
MR. RYAN G WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LO, ABOC, NCLEC
Contact information
Practice address
625 SCHOOL ST, PUTNAM, CT 06260-2424
(860) 630-4634
(860) 928-4975
Mailing address
625 SCHOOL ST, PUTNAM, CT 06260-2424
(860) 630-4634
(860) 928-4975
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1758
CT
Other
Enumeration date
08/04/2017
Last updated
07/21/2022
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