Organization
R JOE WEAVER OD
Active
Other names
Vienna Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSTY JOE WEAVER O.D. (OWNER)
(304) 295-8561
Entity
Organization
Contact information
Practice address
1600 GRAND CENTRAL AVE, VIENNA, WV 26105-1059
(304) 295-8561
(304) 295-9164
Mailing address
PO BOX 5037, VIENNA, WV 26105-5037
(304) 295-8561
(304) 295-9164
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810006279
—
WV
Enumeration date
08/31/2006
Last updated
05/30/2012
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