Healthcare Provider Details

I. General information

NPI: 1518058817
Provider Name (Legal Business Name): VISION CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HOSPITAL DR SUITE 400
LOGAN WV
25601-3451
US

IV. Provider business mailing address

PO BOX 116
LOGAN WV
25601
US

V. Phone/Fax

Practice location:
  • Phone: 304-792-1480
  • Fax:
Mailing address:
  • Phone: 304-792-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20176
License Number StateWV

VIII. Authorized Official

Name: MICHAEL BRIAN BERES
Title or Position: OWNER
Credential: MD
Phone: 304-792-1480