Provider Demographics
NPI:1376548974
Name:HERMAN, JAMES W (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:HERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9622
Mailing Address - Country:US
Mailing Address - Phone:304-757-2533
Mailing Address - Fax:304-757-2354
Practice Address - Street 1:3709 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9622
Practice Address - Country:US
Practice Address - Phone:304-757-2533
Practice Address - Fax:304-757-2354
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV826OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149539000Medicaid
HE0596252Medicare PIN
T32422Medicare UPIN