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General NPI Number Information
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NPI Number | 1477677714
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Entity Type | Organization
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Legal Business Name | TEKAVEC INC.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 2690 WHITE HALL BLVD
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City | FAIRMONT
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State | WV
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Zip | 26554-8226
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Country | US
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Telephone | 304-363-4533
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Fax | 304-366-9809
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Provider Business Mailing Address
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Address Line | 2690 WHITE HALL BLVD
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City | FAIRMONT
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State | WV
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Zip | 26554-8226
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Country | US
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Telephone | 304-363-4533
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Fax | 304-366-9809
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. THOMAS EDWARD TEKAVEC
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Credential | OD
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Telephone | 304-363-4533
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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 | 915OD
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License Number State | WV
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