Healthcare Provider Details

I. General information

NPI: 1609061399
Provider Name (Legal Business Name): THEODORE P WERBLIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 STAFFORD DR
PRINCETON WV
24740-2409
US

IV. Provider business mailing address

1051 STAFFORD DR PO BOX 5879
PRINCETON WV
24740-2409
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-6123
  • Fax: 304-425-2631
Mailing address:
  • Phone: 304-487-6123
  • Fax: 304-425-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12870
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARA WERBLIN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 304-487-6123