Provider Demographics
NPI:1508696220
Name:WEAVER, ERIKA (LDO)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3692
Mailing Address - Country:US
Mailing Address - Phone:559-325-1898
Mailing Address - Fax:559-325-0649
Practice Address - Street 1:323 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3692
Practice Address - Country:US
Practice Address - Phone:559-325-1898
Practice Address - Fax:559-325-0649
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLD43416156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician