1003864976 NPI number — VISION ASSOCIATES, INC.

Table of content: (NPI 1003864976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003864976 NPI number — VISION ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION ASSOCIATES, INC.
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:
Provider Other Organization Name Type Code:
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:
1003864976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25177-0048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-727-8321
Provider Business Mailing Address Fax Number:
304-727-8841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25177-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-727-8321
Provider Business Practice Location Address Fax Number:
304-727-8841
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VICKERS
Authorized Official First Name:
MONTGOMERY
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
304-727-8321

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  701 O.D. , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0150620000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4321742 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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