Provider Demographics
NPI:1306880059
Name:WEAVER, GARTH B (OD)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:B
Last Name:WEAVER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 CRYSTAL BEND DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8304
Mailing Address - Country:US
Mailing Address - Phone:512-252-8717
Mailing Address - Fax:
Practice Address - Street 1:3908 FAR WEST BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2994
Practice Address - Country:US
Practice Address - Phone:512-343-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2900TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E44JMedicare PIN
TXTXB148958Medicare PIN