Weaver, Rusty Joe
Weaver, Rusty Joe is an individual health care provider with primary practice located at 1600 Grand Central Ave , Vienna WV 26105-1059. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Weaver, Rusty Joe can be contacted via phone (304) 295-8561.Contact Information
Primary practice address
1600 Grand Central Ave
Vienna WV 26105-1059
Phone: (304) 295-8561
Fax: (304) 295-9164
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Eye and Vision Services Providers / Optometrist | 152W00000X | 821 OD | West Virginia |
Profile Details
NPI number | 1386692770 |
---|---|
LBN Legal business name | Weaver, Rusty Joe |
Credentials | Doctor of Optometry (OD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 5th, 2006 |
Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1386692770 | NPPES |
West Virginia | MEDICAID | 0149294000 |
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