NPIMap

Organization Active NPI

R Joe Weaver OD

Doing business as Vienna Eye Clinic

  • Optometrist
  • Vienna, WV
National Provider Identifier
1770694390
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
R JOE WEAVER OD
Doing business as
Vienna Eye Clinic
Practice address
1600 Grand Central Ave
Vienna, WV 26105-1059
Phone
(304) 295-8561
Fax
(304) 295-9164
NPI assigned
Aug 31, 2006
Last updated
May 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rusty Joe Weaver, O.D.NPI 1386692770
Title
Owner
Phone
(304) 295-8561

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

1600 Grand Central Ave
Vienna, WV 26105-1059

Mailing address

PO Box 5037
Vienna, WV 26105-5037
Phone (304) 295-8561

Other identifiers 1

IdentifierTypeStateIssuer
3810006279MedicaidWV

Other names 1

  • Vienna Eye Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120522000872 WV Part B Supplier - Clinic/Group Practice 1456455419 Receives reassigned benefits from 4 practitioners
Practice locations: Vienna, WV

National Provider Directory

National Provider Directory

Locations

1600 Grand Central Ave
Vienna, WV 26105
Phone (304) 295-8561

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338336000000",
    "number": "1770694390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5037",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261055037",
            "telephone_number": "304-295-8561",
            "fax_number": "304-295-9164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 GRAND CENTRAL AVE",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261051059",
            "telephone_number": "304-295-8561",
            "fax_number": "304-295-9164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R JOE WEAVER OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-05-30",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "RUSTY",
        "authorized_official_middle_name": "JOE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-295-8561",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006279",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vienna Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vienna, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.