Provider Demographics
NPI:1285829812
Name:PRO EYES OPTOMETRY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PRO EYES OPTOMETRY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-522-2551
Mailing Address - Street 1:3333 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705
Mailing Address - Country:US
Mailing Address - Phone:304-522-2551
Mailing Address - Fax:304-522-2544
Practice Address - Street 1:3333 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705
Practice Address - Country:US
Practice Address - Phone:304-522-2551
Practice Address - Fax:304-522-2544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRO EYES OPTOMETRY ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-06
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 740 D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000101835OtherBLUE CROSS BLUE SHIELD
WV0150722000Medicaid
WV0150722000Medicaid
WV=========OtherAETNA
WVT32587Medicare UPIN