MEDICARE: REGIONAL EYE ASSOCIATES, 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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801066410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL EYE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	1255 PINEVIEW DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-2713
Country	:	US
Telephone Number	:	304-598-3301
Fax Number	:	304-599-7346

Provider Business Practice Location Address
First Line	:	110 CAMBRIDGE PL
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330-2812
Country	:	US
Telephone Number	:	304-842-4070
Fax Number	:	304-599-7346

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN R POWELL
Credential	:	M.D.
Telephone Number	:	304-598-3301

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	03/11/2008

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