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General NPI Number Information
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NPI Number | 1003977935
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Entity Type | Organization
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Legal Business Name | ELKINS OPTICAL CENTER INC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 635 ROBERT E LEE AVE
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City | ELKINS
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State | WV
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Zip | 26241
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Country | US
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Telephone | 304-636-8510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2569 635 ROBT E LEE AVE
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City | ELKINS
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State | WV
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Zip | 26241
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Country | US
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Telephone | 304-636-8510
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Fax |
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Authorized Official
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Title or Position | PRES OWNER OPTICIAN
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Name | MRS. BRENDA LEA RAMSEY
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Credential | COT
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Telephone | 304-636-8510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2007003214
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License Number State | WV
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