Provider Demographics
NPI:1205169125
Name:JENNIFER L WEAVER O.D., LLC
Entity type:Organization
Organization Name:JENNIFER L WEAVER O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-313-2722
Mailing Address - Street 1:8425 PULSAR PL
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2079
Mailing Address - Country:US
Mailing Address - Phone:614-885-9355
Mailing Address - Fax:614-885-9359
Practice Address - Street 1:8425 PULSAR PL
Practice Address - Street 2:SUITE 240
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2079
Practice Address - Country:US
Practice Address - Phone:614-885-9355
Practice Address - Fax:614-885-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty