Provider Demographics
NPI:1356501837
Name:DR STEPHEN L. GAAL & ASSOCIATES
Entity Type:Organization
Organization Name:DR STEPHEN L. GAAL & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-736-4942
Mailing Address - Street 1:PO BOX 4188
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4188
Mailing Address - Country:US
Mailing Address - Phone:304-736-4942
Mailing Address - Fax:304-736-4943
Practice Address - Street 1:1013 TOWN CENTER MALL
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25389
Practice Address - Country:US
Practice Address - Phone:304-736-4942
Practice Address - Fax:304-736-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV930 OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9283831Medicare PIN
WV9283832Medicare PIN
U66255Medicare UPIN