Provider Demographics
NPI:1326265232
Name:WEAVER, JAMES ROBERT JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2011 ADMIRALTY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5216
Mailing Address - Country:US
Mailing Address - Phone:321-632-0808
Mailing Address - Fax:
Practice Address - Street 1:1900 MASON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5103
Practice Address - Country:US
Practice Address - Phone:386-274-5525
Practice Address - Fax:386-274-5585
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD934Medicare PIN
FLAD934VMedicare PIN
FLAD934XMedicare PIN
FLAD934WMedicare PIN