Provider Demographics
NPI:1003446444
Name:REGIONAL EYE ASSOCIATES, INC
Entity Type:Organization
Organization Name:REGIONAL EYE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAMPONIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-598-3301
Mailing Address - Street 1:1255 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2738
Mailing Address - Country:US
Mailing Address - Phone:304-598-3301
Mailing Address - Fax:
Practice Address - Street 1:402 MEDICAL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-1678
Practice Address - Country:US
Practice Address - Phone:304-406-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty