Healthcare Provider Details

I. General information

NPI: 1730503038
Provider Name (Legal Business Name): MED SURG EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MALLARD CT
BECKLEY WV
25801-3615
US

IV. Provider business mailing address

PO BOX 172
STANAFORD WV
25927-0172
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-4216
  • Fax: 304-253-6809
Mailing address:
  • Phone: 304-252-4216
  • Fax: 304-253-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20564
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TAOUFIK A SADAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-252-4616