MR. OTIS WEAVER (NPI# 1801292016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801292016 |
| Entity Type | Individual |
| Full Name | MR. OTIS WEAVER |
| Credential | LICENSED OPTICIAN |
| Practice Address |
4765 Memorial Dr Decatur GA 30032-1417 |
| Mailing Address |
5391 Radford Ln Lithonia GA 30038-2899 |
| Practice Telephone | 4042962307 |
| Mailing Telephone | 4042194309 |
| Enumeration Date | 2014-11-16 |
| Last Update Date | 2014-11-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
LDO001204 | GA | Eye and Vision Services Providers |
| Street Address |
4765 MEMORIAL DR |
| City | DECATUR |
| State | GA |
| Zip Code | 30032-1417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801916812 | Dan Martin Smyly | Technician/Technologist | 4765 Memorial Dr, Decatur, GA 30032-1417 | 2007-03-31 |
| 1851763916 | Mary N, Brunner, LLC | Optometrist | 4765 Memorial Dr, Decatur, GA 30032-1417 | 2015-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861028078 | Anchor Home Healthcare Services, Inc. | Community/Behavioral Health | 3717 Elkridge Drive, Decatur, GA 30032 | 2020-03-19 |
| 1578959201 | Trusted Nurses | Nursing Care | 1959 Barberrie Ln, Decatur, GA 30032 | 2015-04-09 |
| 1225436751 | God's Helper's Private Home Care, LLC | In Home Supportive Care | 1916 Willa Dr, Decatur, GA 30032 | 2014-12-16 |
| 1366878712 | Teresa A Johnson | Counselor | 1585 Cobbs Creek Lane, Decatur, GA 30032 | 2013-09-17 |
| 1629213590 | Curlen L Baird-scott | Registered Nurse | Child and Adolescent Stabilization Unit, 2591 Candler Road, Decatur, GA 30032 | 2008-12-08 |
| 1659527919 | Louis Aaron Calderon | Psychiatry & Neurology | 3408 Covington Highway, Georgia Department of Juvenile Justice, Decatur, GA 30032 | 2008-08-18 |
| 1932387982 | Turning Point Behavioral Health and Wellness Center | Community/Behavioral Health | 4292 Memorial Drive Suite C, Decatur, GA 30032 | 2008-02-01 |
| 1528190865 | Jennifer Weeks Kaufman | Speech-Language Pathologist | 1441 Clifton Road Ne, Atlanta, GA 30032 | 2007-03-12 |
| 1093847147 | Mary Sprague | Speech-Language Pathologist | 1441 Clifton Road North East, Atlanta, GA 30032 | 2007-03-12 |
| 1356479976 | Julie Witten | Speech-Language Pathologist | 1441 Clifton Road, N.e., Atlanta, GA 30032 | 2007-03-02 |
| Find all providers in zip 30032 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427393206 | Vision Plus L.L.C. | Technician/Technologist | 3285 Midway Rd, 113, Decatur, GA 30032-2825 | 2012-12-04 |
| 1952634206 | Luis Felipe Roman | Technician/Technologist | 335 W Ponce De Leon Ave, Suite F, Decatur, GA 30030-2451 | 2009-09-17 |
| 1801916812 | Dan Martin Smyly | Technician/Technologist | 4765 Memorial Dr, Decatur, GA 30032-1417 | 2007-03-31 |
| 1306929955 | Wal-mart Stores, Inc | Technician/Technologist | 4224 N Prospect St, Decatur, IL 62526-6100 | 2006-10-24 |
| 1093896193 | Wal-mart Stores Texas, Lp | Technician/Technologist | 800 S Highway 287, Decatur, TX 76234-1656 | 2006-10-17 |
| 1306217930 | Wal-mart Stores East, Lp | Technician/Technologist | 2525 N Decatur Rd, Decatur, GA 30033-6126 | 2015-10-08 |
| 1548489156 | John Marsh | Technician/Technologist | 1756 Candler Rd, Decatur, GA 30032-3277 | 2007-04-24 |
| 1457575680 | Fashion Optique Eyewear, Inc | Technician/Technologist | 2851 Candler Rd, Suite 100, Decatur, GA 30034-1412 | 2007-04-12 |
| 1336223973 | Wal-mart Stores, Inc | Technician/Technologist | 4625 E Maryland St, Decatur, IL 62521-5092 | 2006-10-24 |
| 1548350994 | Wal-mart Stores East, Lp | Technician/Technologist | 1700 S 13th St, Decatur, IN 46733-2190 | 2006-10-14 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.