Provider Demographics
NPI:1801817317
Name:WEAVER, CHRISTIE ALTICE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:ALTICE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13995 U.S. HIGHWAY 29, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531
Mailing Address - Country:US
Mailing Address - Phone:434-432-9752
Mailing Address - Fax:434-432-8580
Practice Address - Street 1:CHATHAM FAMILY EYECARE CENTER
Practice Address - Street 2:13995 US HIGHWAY 29 SUITE 100
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531
Practice Address - Country:US
Practice Address - Phone:434-432-9752
Practice Address - Fax:434-432-8580
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009237267Medicaid
VA462613OtherANTHEM
VA00V277W53Medicare ID - Type Unspecified
VA462613OtherANTHEM