Individual
MR. OTIS WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
Contact information
Practice address
4765 MEMORIAL DR, DECATUR, GA 30032-1417
(404) 296-2307
Mailing address
5391 RADFORD LN, LITHONIA, GA 30038-2899
(404) 219-4309
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO001204
GA
Other
Enumeration date
11/16/2014
Last updated
11/16/2014
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