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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 19 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386692770 NPPES
West Virginia MEDICAID 0149294000

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