Healthcare Provider Details

I. General information

NPI: 1346628393
Provider Name (Legal Business Name): ACCESS VISION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 ROBERT C. BYRD DR.
BECKLEY WV
25801
US

IV. Provider business mailing address

1623 ROBERT C. BYRD DR.
BECKLEY WV
25801
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-3937
  • Fax: 304-256-6574
Mailing address:
  • Phone: 304-256-3937
  • Fax: 304-256-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number926IOD
License Number StateWV

VIII. Authorized Official

Name: DR. DAVID BRENT GOMEZ
Title or Position: DOCTOR / MANAGER
Credential: O.D.
Phone: 304-256-3937