Provider Demographics
NPI:1346245263
Name:WEAVER, EDWARD JR (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 FLORAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6216
Mailing Address - Country:US
Mailing Address - Phone:910-791-6086
Mailing Address - Fax:
Practice Address - Street 1:1205 FLORAL PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6216
Practice Address - Country:US
Practice Address - Phone:910-791-6086
Practice Address - Fax:910-392-8087
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909965Medicaid
NC0250HOtherBCBS PROVIDER ID
NCT65041Medicare UPIN
NC7909965Medicaid