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General NPI Number Information
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NPI Number | 1205243177
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Entity Type | Individual
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Provider Name | GREGORY SHAWN SAMMONS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2014
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 3709 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9645
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Country | US
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Telephone | 304-757-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 3709 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9645
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Country | US
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Telephone | 304-757-2533
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Fax | 304-757-2534
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2010-IOD
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License Number State | WV
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