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General NPI Number Information
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NPI Number | 1598965709
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Entity Type | Individual
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Provider Name | PETER G DORMAS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 2106 LUMBER AVE
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City | WHEELING
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State | WV
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Zip | 26003-5390
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Country | US
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Telephone | 304-242-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 119 GLENN AVE
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City | SAINT CLAIRSVILLE
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State | OH
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Zip | 43950-9725
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Country | US
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Telephone | 614-397-5041
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Fax |
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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 | 1046
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License Number State | WV
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