Otis Weaver, Licensed Optician
Technician/Technologist, Optician in Decatur, GA. Individual provider (NPI-1).
NPI number1801292016
StatusActive
Last updated in NPPESNov 16, 2014
Details
- NPI
- 1801292016
- Entity type
- Individual (NPI-1)
- Name
- Mr. Otis Weaver
- Credential
- Licensed Optician
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 16, 2014
- Last updated
- Nov 16, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | LDO001204 | GA | Yes |
Practice location
4765 Memorial DrDecatur, GA 30032-1417
Phone 404-296-2307
Mailing address
5391 Radford LnLithonia, GA 30038-2899
Phone 404-219-4309
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All 12 Optician providers in Decatur · All 6,698 providers in Decatur
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