MEDICARE: TRI-STATE EYE CENTER PLLC

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	152W00000X	Optometrist	1030-OD	WV

General Provider Information

NPI Number	:	1912237579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE EYE CENTER PLLC

Provider Business Mailing Address
First Line	:	117 THREE SPRINGS DR
Second Line	:	SUITE C
City	:	WEIRTON
State	:	WV
Zip	:	26062-3827
Country	:	US
Telephone Number	:	304-723-0477
Fax Number	:	304-723-0778

Provider Business Practice Location Address
First Line	:	117 THREE SPRINGS DR
Second Line	:	SUITE C
City	:	WEIRTON
State	:	WV
Zip	:	26062-3827
Country	:	US
Telephone Number	:	304-723-0477
Fax Number	:	304-723-0778

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. ALVIN GINIER
Credential	:	O.D.
Telephone Number	:	304-723-0477

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	05/17/2010

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