Provider Demographics
NPI:1003810557
Name:UNIVERSITY PHYSICIANS & SURGEONS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS & SURGEONS, INC.
Other - Org Name:UNIVERSITY EYE SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-691-1602
Mailing Address - Street 1:1616 13TH AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3840
Mailing Address - Country:US
Mailing Address - Phone:304-697-0393
Mailing Address - Fax:304-697-0395
Practice Address - Street 1:1616 13TH AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3840
Practice Address - Country:US
Practice Address - Phone:304-697-0393
Practice Address - Fax:304-697-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0393766Medicaid
WV0009196000Medicaid
KY65902892Medicaid
KY77903904Medicaid
KY77903904Medicaid