Healthcare Provider Details

I. General information

NPI: 1518006154
Provider Name (Legal Business Name): MORGANTOWN EYE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HAMPTON CTR STE A
MORGANTOWN WV
26505-1708
US

IV. Provider business mailing address

3000 HAMPTON CTR STE A
MORGANTOWN WV
26505-1708
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2020
  • Fax: 304-598-2024
Mailing address:
  • Phone: 304-598-2020
  • Fax: 304-598-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. THOMAS ADEN STOUT
Title or Position: DOCTOR
Credential: O.D.
Phone: 304-598-2020