Healthcare Provider Details

I. General information

NPI: 1174551196
Provider Name (Legal Business Name): ACCESS VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 ROBERT C. BYRD DR
CRAB ORCHARD WV
25827
US

IV. Provider business mailing address

1623 ROBERT C. BYRD DR
CRAB ORCHARD WV
25827
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 Number
License Number State

VIII. Authorized Official

Name: DR. DAVID B GOMEZ
Title or Position: OWNER
Credential: O.D.
Phone: 304-256-3937