MEDICARE: OPTOMETRIC PHYSICIANS OF PARKERSBURG INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist

General Provider Information

NPI Number	:	1659459592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTOMETRIC PHYSICIANS OF PARKERSBURG INC

Provider Business Mailing Address
First Line	:	416 DIVISION ST
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-5619
Country	:	US
Telephone Number	:	304-485-7485
Fax Number	:	304-485-5410

Provider Business Practice Location Address
First Line	:	416 DIVISION ST
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-5619
Country	:	US
Telephone Number	:	304-485-7485
Fax Number	:	304-485-5410

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	PATTY R REYNOLDS
Credential	:
Telephone Number	:	304-485-7588

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/28/2010

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