Provider Demographics
NPI:1528049004
Name:WEAVER, RICHARD C (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
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:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-0359
Mailing Address - Country:US
Mailing Address - Phone:254-939-5261
Mailing Address - Fax:254-939-6610
Practice Address - Street 1:2609 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1521
Practice Address - Country:US
Practice Address - Phone:254-939-5261
Practice Address - Fax:254-939-6610
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02514TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020154303Medicaid
TXT16512Medicare UPIN
TX020154301Medicaid
TX0381430001Medicare NSC