Provider Demographics
NPI:1093020158
Name:WEAVER EYE CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WEAVER EYE CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:JON
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-488-5315
Mailing Address - Street 1:7185 BERNVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BERNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19506-8624
Mailing Address - Country:US
Mailing Address - Phone:610-488-5315
Mailing Address - Fax:610-488-5296
Practice Address - Street 1:7185 BERNVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-8624
Practice Address - Country:US
Practice Address - Phone:610-488-5315
Practice Address - Fax:610-488-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3804266000OtherINDEPENDENCE BLUE CROSS
PA207044OtherMEDICARE PTAN
PA3234646OtherUNITED HEALTHCARE
PA9784584OtherAETNA