Provider Demographics
NPI:1356778252
Name:REESE & WEAVER DDS LLC
Entity type:Organization
Organization Name:REESE & WEAVER DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:801-756-7150
Mailing Address - Street 1:11038 N. HIGHLAND BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-756-7150
Mailing Address - Fax:801-642-0938
Practice Address - Street 1:11038 N. HIGHLAND BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-756-7150
Practice Address - Fax:801-642-0938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348323-9934152W00000X
UT5350538-8904152W00000X
UT328345-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty