Individual
BRENDON J WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001233
PA
152WC0802X
Corneal and Contact Management Optometrist
OEG001233
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009637000001
—
PA
01
—
1598378
HIGHMARK BLUE SHIELD
PA
01
—
2277395000
INDEPENDENCE BLUE CROSS
—
01
—
2397071
UNITED HEALTHCARE
PA
01
—
50053706
CAPITAL BLUE CROSS
PA
01
—
7964550
AETNA
PA
Enumeration date
04/03/2006
Last updated
06/06/2011
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