Healthcare Provider Details

I. General information

NPI: 1154593911
Provider Name (Legal Business Name): THOMAS E. GRIFFITH O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 4TH AVE
SAINT ALBANS WV
25177-2821
US

IV. Provider business mailing address

205 4TH AVE
SAINT ALBANS WV
25177-2821
US

V. Phone/Fax

Practice location:
  • Phone: 304-727-5237
  • Fax: 304-727-4051
Mailing address:
  • Phone: 304-727-5237
  • Fax: 304-727-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number608-OD
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS E GRIFFITH
Title or Position: OWNER
Credential: O.D.
Phone: 304-727-5237