Provider Demographics
NPI:1073699815
Name:ENVISION OPTICAL
Entity Type:Organization
Organization Name:ENVISION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ALLARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-720-3937
Mailing Address - Street 1:310 35TH ST SE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1352
Mailing Address - Country:US
Mailing Address - Phone:304-720-3937
Mailing Address - Fax:304-926-0958
Practice Address - Street 1:310 35TH ST SE
Practice Address - Street 2:SUITE 11
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1352
Practice Address - Country:US
Practice Address - Phone:304-720-3937
Practice Address - Fax:304-926-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV4971OtherEYEMED
WVB42712Medicare UPIN
WVWV4971OtherEYEMED