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General NPI Number Information
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NPI Number | 1003446444
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Entity Type | Organization
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Legal Business Name | REGIONAL EYE ASSOCIATES, INC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 402 MEDICAL PARK DR STE 100
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City | WESTON
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State | WV
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Zip | 26452-1678
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Country | US
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Telephone | 304-406-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 PINEVIEW DR
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City | MORGANTOWN
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State | WV
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Zip | 26505-2738
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Country | US
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Telephone | 304-598-3301
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | EDGAR C GAMPONIA
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Credential |
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Telephone | 304-598-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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