1629280946 NPI number — SAMUEL L. WEIR, O.D., P.C.

Table of content: (NPI 1629280946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629280946 NPI number — SAMUEL L. WEIR, O.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMUEL L. WEIR, O.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629280946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
528 WATERLOO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20186-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-347-0555
Provider Business Mailing Address Fax Number:
540-347-9198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
528 WATERLOO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20186-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-347-0555
Provider Business Practice Location Address Fax Number:
540-347-9198
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEIR
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
540-347-0555

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618000249 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 0618001510 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0671590 . This is a "SAMUEL WEIR AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7304730 . This is a "AETNA GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 075587 . This is a "SAMUEL WEIR ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11505363 . This is a "SHANNON COLBOURNE UHC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1619933280 . This is a "SAMUEL WEIR NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2140911 . This is a "SHANNON COLBOURNE MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1629280946 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 187369 . This is a "SHANNON COLBOURNE ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 231169 . This is a "SAMUEL WEIR MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3991583 . This is a "SHANNON COLBOURNE AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C09621 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 11230897 . This is a "SAMUEL WEIR UHC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1689630246 . This is a "SHANNON COLBOURNE NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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