Provider Demographics
NPI:1518065838
Name:WEAVER, ELIZABETH DUBE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DUBE
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 1:8287 PINE RUN
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8673
Mailing Address - Country:US
Mailing Address - Phone:251-454-2768
Mailing Address - Fax:
Practice Address - Street 1:101 E I65 SERVICE RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3900
Practice Address - Country:US
Practice Address - Phone:251-471-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA17TA607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009919175Medicaid
AL051553429WEAMedicare ID - Type Unspecified
ALU91916Medicare UPIN