Healthcare Provider Details

I. General information

NPI: 1043222961
Provider Name (Legal Business Name): EYE AND EAR CLINIC PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 KANAWHA BLVD E
CHARLESTON WV
25301-3001
US

IV. Provider business mailing address

1306 KANAWHA BLVD E
CHARLESTON WV
25301-3001
US

V. Phone/Fax

Practice location:
  • Phone: 304-353-0222
  • Fax: 304-353-0218
Mailing address:
  • Phone: 304-353-0222
  • Fax: 304-353-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number00848
License Number StateWV

VIII. Authorized Official

Name: MS. CHRISTINA JANE ARVON
Title or Position: ADMINISTRATOR,CPA
Credential:
Phone: 304-353-0303