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General NPI Number Information
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NPI Number | 1780929091
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC ASSOCIATES, INC
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 404 HUNTINGTON MALL UNIT 580
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1828
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Country | US
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Telephone | 304-736-4942
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Fax |
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Provider Business Mailing Address
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Address Line | 404 HUNTINGTON MALL UNIT 580 PO BOX 4088
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | ALVIN GINIER
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Credential |
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Telephone | 304-736-4942
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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 | 1030-OD
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License Number State | WV
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