Healthcare Provider Details

I. General information

NPI: 1548594856
Provider Name (Legal Business Name): NEW RIVER VISION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ELIZABETH ST
OAK HILL WV
25901-2342
US

IV. Provider business mailing address

1001 ELIZABETH ST
OAK HILL WV
25901-2342
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-0269
  • Fax: 304-465-1966
Mailing address:
  • Phone: 304-465-0269
  • Fax: 304-465-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1067-OD
License Number StateWV

VIII. Authorized Official

Name: DR. CASSANDRA L ORTIZ
Title or Position: OWNER/ MANAGING MEMBER
Credential: O.D., M.S.
Phone: 304-465-0269