Provider Demographics
NPI:1033246343
Name:WEAVER, MARK A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:5804 BURROUGH DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3468
Mailing Address - Country:US
Mailing Address - Phone:512-567-2020
Mailing Address - Fax:
Practice Address - Street 1:1502 STRICKLAND DR STE 4
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-2978
Practice Address - Country:US
Practice Address - Phone:409-330-4324
Practice Address - Fax:409-330-4209
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5041T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU51088Medicare UPIN