Individual
DR. RUSTY JOE WEAVER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1600 GRAND CENTRAL AVE, VIENNA, WV 26105-1059
(304) 295-8561
(304) 295-9164
Mailing address
1600 GRAND CENTRAL AVE, VIENNA, WV 26105-1059
(304) 295-8561
(304) 295-9164
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
821 OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0149294000
—
WV
Enumeration date
05/05/2006
Last updated
07/08/2007
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