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Mr. Otis Weaver, LICENSEDOPTICIAN
Optician in Decatur, Georgia
NPI 1801292016

Otis Weaver is a Optician based in Lithonia, GA and is specialized in Optician. Otis Weaver practices in Decatur, GA and has the professional credentials of LICENSEDOPTICIAN. The NPI Number for Otis Weaver is 1801292016 and holds a License No. LDO001204 (Georgia).

The current practice location address for Otis Weaver is 4765 Memorial Dr, Decatur, GA and can be reached out via phone at 404-296-2307.

Location: 4765 Memorial Dr, Decatur, GA, 30038-2899
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1801292016
Provider Name
Otis Weaver
Credential
LICENSEDOPTICIAN
Provider Entity Type
Individual
Gender
Male
Address
4765 Memorial Dr, Decatur, GA, 30038-2899
Phone Number
404-296-2307
Fax Number
Provider Enumeration Date
11/16/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
4765 Memorial Dr
City
Decatur
State
Georgia
Zip
30032-1417
Phone Number
404-296-2307
Fax Number
person
Provider Business Mailing Address Details
Address
4765 Memorial Dr
City
Decatur
State
Georgia
Zip
30032-1417
Phone Number
404-296-2307
Fax Number
person
Provider's Taxonomy Details 1
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Optician
Taxonomy
156FX1800X
License No.
LDO001204 (Georgia)
Definition
Definition to come...
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