Provider Demographics
NPI:1619933280
Name:WEIR, SAMUEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:WEIR
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 1:5844 UNIVERSITY CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-9329
Mailing Address - Country:US
Mailing Address - Phone:540-347-0555
Mailing Address - Fax:540-347-9198
Practice Address - Street 1:528 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3011
Practice Address - Country:US
Practice Address - Phone:540-347-0555
Practice Address - Fax:540-347-9198
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA075587OtherANTHEM BCBS
VA11230897OtherUHC
VA0671590OtherAETNA
VA231169OtherMAMSI
VA11230897OtherUHC
VA075587OtherANTHEM BCBS