Healthcare Provider Details

I. General information

NPI: 1659459592
Provider Name (Legal Business Name): OPTOMETRIC PHYSICIANS OF PARKERSBURG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 DIVISION ST
PARKERSBURG WV
26101-5619
US

IV. Provider business mailing address

416 DIVISION ST
PARKERSBURG WV
26101-5619
US

V. Phone/Fax

Practice location:
  • Phone: 304-485-7485
  • Fax: 304-485-5410
Mailing address:
  • Phone: 304-485-7485
  • Fax: 304-485-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: PATTY R REYNOLDS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 304-485-7588