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Individual

DR. JEFFREY LANCE WEAVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1200 W GODFREY AVE, PHILADELPHIA, PA 19141-3323
(215) 276-6000
(215) 276-1329
Mailing address
3662 BOSTONS FARM DR, BRIDGETON, MO 63044-3167
(314) 952-2226
(314) 228-2020

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
2042
OR
152W00000X
Optometrist
4248T125
OH
152W00000X
Optometrist
Primary
OEG003775
PA
152W00000X
Optometrist
T02793
MO

Other

Enumeration date
09/13/2006
Last updated
05/22/2025
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