Provider Demographics
NPI:1629280946
Name:SAMUEL L. WEIR, O.D., P.C.
Entity Type:Organization
Organization Name:SAMUEL L. WEIR, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-347-0555
Mailing Address - Street 1:528 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3011
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000249152W00000X
VA0618001510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0671590OtherSAMUEL WEIR AETNA
VA7304730OtherAETNA GROUP NUMBER
VA075587OtherSAMUEL WEIR ANTHEM
VA11505363OtherSHANNON COLBOURNE UHC
VA1619933280OtherSAMUEL WEIR NPI
VA2140911OtherSHANNON COLBOURNE MAMSI
VA1629280946OtherGROUP NPI NUMBER
VA187369OtherSHANNON COLBOURNE ANTHEM
VA231169OtherSAMUEL WEIR MAMSI
VA3991583OtherSHANNON COLBOURNE AETNA
VAC09621OtherMEDICARE GROUP NUMBER
VA11230897OtherSAMUEL WEIR UHC
VA1689630246OtherSHANNON COLBOURNE NPI
VA7304730OtherAETNA GROUP NUMBER
VAT21327Medicare UPIN
VAV06609Medicare UPIN
VA0672330001Medicare NSC