Healthcare Provider Details

I. General information

NPI: 1023118841
Provider Name (Legal Business Name): WHITE EYE CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 GEORGE KOSTAS DR
LOGAN WV
25601-3747
US

IV. Provider business mailing address

407 GEORGE KOSTAS DR
LOGAN WV
25601-3747
US

V. Phone/Fax

Practice location:
  • Phone: 304-752-2020
  • Fax: 304-752-5600
Mailing address:
  • Phone: 304-752-2020
  • Fax: 304-752-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MASON E WHITE
Title or Position: OWNER
Credential:
Phone: 304-752-2020