Individual
DR. KYLE JONATHAN WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2740 NAVARRE AVE, OREGON, OH 43616
(419) 693-4444
(419) 697-2149
Mailing address
4100 W 3RD ST, DAYTON, OH 45428-9000
(260) 729-2311
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003711A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0233917
—
OH
Enumeration date
03/15/2012
Last updated
08/14/2018
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