1003842790 NPI number — OHIO VALLEY EYE PHYSICIANS & SURGEONS PLLC

Table of content: (NPI 1003842790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003842790 NPI number — OHIO VALLEY EYE PHYSICIANS & SURGEONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO VALLEY EYE PHYSICIANS & SURGEONS PLLC
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:
OHIO VALLEY EYE PHYSICIANS & SURGEONS, PLLC
Provider Other Organization Name Type Code:
3
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:
1003842790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 GRAND PARK DR
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26105-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-428-3500
Provider Business Mailing Address Fax Number:
304-422-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 GRAND PARK DR
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26105-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-428-3500
Provider Business Practice Location Address Fax Number:
304-422-7900
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
SPENCER
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
304-428-3500

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00449568 . This is a "MOUNTAIN STATE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008970-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: CL8195 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2797773 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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