Provider Demographics
NPI:1689663114
Name:WEAVER, MORRIS HOWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:HOWARD
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 1:842 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-8629
Mailing Address - Country:US
Mailing Address - Phone:850-874-2864
Mailing Address - Fax:850-234-0775
Practice Address - Street 1:10270 FRONT BEACH RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3808
Practice Address - Country:US
Practice Address - Phone:850-234-0775
Practice Address - Fax:850-234-5701
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20573AMedicare ID - Type Unspecified
FLU56105Medicare UPIN