Provider Demographics
NPI:1548432206
Name:WEAVER, TODD MICHIAL
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:MICHIAL
Last Name:WEAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 HIGHWAY 180 E STE 7
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-4774
Mailing Address - Country:US
Mailing Address - Phone:940-328-0011
Mailing Address - Fax:817-423-1115
Practice Address - Street 1:2801 HIGHWAY 180 E STE 7
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-4774
Practice Address - Country:US
Practice Address - Phone:940-328-0011
Practice Address - Fax:817-423-1115
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician