Provider Demographics
NPI:1851468953
Name:REESE AND WEAVER, ODS LLC
Entity Type:Organization
Organization Name:REESE AND WEAVER, ODS LLC
Other - Org Name:ALPINE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-768-1900
Mailing Address - Street 1:37 E COMMERCE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045
Mailing Address - Country:US
Mailing Address - Phone:801-768-1900
Mailing Address - Fax:801-768-1904
Practice Address - Street 1:76 E COMMERCE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045
Practice Address - Country:US
Practice Address - Phone:801-768-1900
Practice Address - Fax:801-768-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328345--9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1851468953Medicaid
UT1851468953Medicaid