Provider Demographics
NPI:1104199892
Name:ELECTRA VISION, LLC.
Entity Type:Organization
Organization Name:ELECTRA VISION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTARAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-724-2025
Mailing Address - Street 1:217 OAK LEE DR
Mailing Address - Street 2:SUITE 12B
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-4871
Mailing Address - Country:US
Mailing Address - Phone:304-724-2025
Mailing Address - Fax:
Practice Address - Street 1:217 OAK LEE DR
Practice Address - Street 2:SUITE 12B
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-4871
Practice Address - Country:US
Practice Address - Phone:304-724-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-12
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1021-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVA852Medicare PIN