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General NPI Number Information
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NPI Number | 1679627558
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATE EYE CENTER
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | RR 3 BOX 3300
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City | KEYSER
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State | WV
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Zip | 26726-9481
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Country | US
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Telephone | 304-788-7800
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Fax |
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Provider Business Mailing Address
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Address Line | RR 3 BOX 3300
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City | KEYSER
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State | WV
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Zip | 26726-9481
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Country | US
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Telephone | 304-788-7800
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STACY K RAPSON
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Credential |
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Telephone | 301-722-6480
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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 | 897-D
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License Number State | WV
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