Provider Demographics
NPI:1043087133
Name:CHEAT LAKE EYE CARE, PLLC
Entity Type:Organization
Organization Name:CHEAT LAKE EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HALLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-288-2325
Mailing Address - Street 1:1307 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9177
Mailing Address - Country:US
Mailing Address - Phone:304-288-2325
Mailing Address - Fax:
Practice Address - Street 1:700 FORT PIERPONT DR STE 106
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1389
Practice Address - Country:US
Practice Address - Phone:304-288-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty