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General NPI Number Information
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NPI Number | 1124340559
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Entity Type | Organization
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Legal Business Name | FAMILY VISION CARE INC
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 04/25/2010
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Provider Practice Location Address
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Address Line | 100 FAYETTE TOWN CTR
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-9539
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Country | US
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Telephone | 304-574-3557
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Fax |
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Provider Business Mailing Address
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Address Line | 100 FAYETTE TOWN CTR
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City | FAYETTEVILLE
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State | WV
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Zip | 25840-9539
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Country | US
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Telephone | 304-574-3557
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. WILLIAM E PUGH III
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Credential | OD
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Telephone | 303-640-4258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1042-OD
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License Number State | WV
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