=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699781385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN EYE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 AMALIA DR STE C3
-----------------------------------------------------
City | BUCKHANNON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26201-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-472-2100
-----------------------------------------------------
Fax | 304-472-2118
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 AMALIA DRIVE
-----------------------------------------------------
City | BUCKHANNON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-472-2100
-----------------------------------------------------
Fax | 304-472-2118
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | NORMA L HAYMOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-472-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------