Provider Demographics
NPI:1578596425
Name:WEAVER, SHON ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:SHON
Middle Name:ANTHONY
Last Name:WEAVER
Suffix:
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 1:701 SMELTER AVE NE
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1940
Mailing Address - Country:US
Mailing Address - Phone:406-471-9268
Mailing Address - Fax:
Practice Address - Street 1:701 SMELTER AVE NE
Practice Address - Street 2:VISION CENTER
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1940
Practice Address - Country:US
Practice Address - Phone:406-471-9268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT26-3478480OtherTAX ID
62465OtherUPIN