Individual
KRISTINE MARIE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2393 SCHUST RD, SAGINAW, MI 48603-1334
(989) 793-2820
(989) 755-1463
Mailing address
2393 SCHUST RD, SAGINAW, MI 48603-1334
(989) 793-2820
(989) 793-9132
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004490
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699939751
—
MI
01
—
382334055
TAX ID
—
01
—
900G310710
BLUE CROSS
—
Enumeration date
07/17/2008
Last updated
09/18/2023
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