Provider Demographics
NPI:1225552425
Name:WEAVER, EMILY WILSON (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WILSON
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-9540
Mailing Address - Country:US
Mailing Address - Phone:717-741-4788
Mailing Address - Fax:717-747-9111
Practice Address - Street 1:2791 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9540
Practice Address - Country:US
Practice Address - Phone:717-741-4788
Practice Address - Fax:717-747-9111
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist