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General NPI Number Information
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NPI Number | 1407936925
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Entity Type | Organization
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Legal Business Name | ELI DRAGISICH OD INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 705 COLLIERS WAY
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City | WEIRTON
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State | WV
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Zip | 26062-5016
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Country | US
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Telephone | 304-723-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 705 COLLIERS WAY
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City | WEIRTON
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State | WV
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Zip | 26062-5016
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Country | US
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Telephone | 304-723-1280
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELI DRAGISICH
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Credential | O.D.
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Telephone | 304-723-1280
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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 | 599OD
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License Number State | WV
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