Healthcare Provider Details

I. General information

NPI: 1053473827
Provider Name (Legal Business Name): FICK EYECARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 TYGART MALL RD INSIDE WALMART
FAIRMONT WV
26554
US

IV. Provider business mailing address

PO BOX 5096 WHITEHALL STATION
FAIRMONT WV
26555-5096
US

V. Phone/Fax

Practice location:
  • Phone: 304-366-3425
  • Fax:
Mailing address:
  • Phone: 304-366-3425
  • Fax: 304-366-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JIM M FICK
Title or Position: PRESIDENT
Credential: OD
Phone: 304-739-2698