Healthcare Provider Details

I. General information

NPI: 1205998648
Provider Name (Legal Business Name): REGIONAL EYE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 PINEVIEW DR
MORGANTOWN WV
26505
US

IV. Provider business mailing address

1255 PINEVIEW DR
MORGANTOWN WV
26505-2713
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-5777
  • Fax: 304-598-5754
Mailing address:
  • Phone: 304-598-3301
  • Fax: 304-599-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN R POWELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 304-598-3301