1699121772 NPI number — FOR YOUR EYES ONLY OPTOMETRISTS, P.L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699121772 NPI number — FOR YOUR EYES ONLY OPTOMETRISTS, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOR YOUR EYES ONLY OPTOMETRISTS, P.L.L.C.
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:
1699121772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 CASINO DRIVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ANMOORE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26323-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-624-3937
Provider Business Mailing Address Fax Number:
304-623-1189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 CASINO DRIVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ANMOORE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26323-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-624-3937
Provider Business Practice Location Address Fax Number:
304-623-1189
Provider Enumeration Date:
05/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ZALAR
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER / OPTOMETRIST
Authorized Official Telephone Number:
540-604-7840

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2006-IOD , 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)





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