Provider Demographics
NPI:1770713810
Name:MARK A WEAVER O D INC
Entity type:Organization
Organization Name:MARK A WEAVER O D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-567-2020
Mailing Address - Street 1:5804 BURROUGH DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3468
Mailing Address - Country:US
Mailing Address - Phone:512-567-2020
Mailing Address - Fax:
Practice Address - Street 1:1502 STRICKLAND DR STE 4
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-2978
Practice Address - Country:US
Practice Address - Phone:409-330-4324
Practice Address - Fax:409-330-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU51088Medicare UPIN