Provider Demographics
NPI:1477677714
Name:TEKAVEC INC.
Entity Type:Organization
Organization Name:TEKAVEC INC.
Other - Org Name:EYECAREONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TEKAVEC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-363-4533
Mailing Address - Street 1:2690 WHITE HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8226
Mailing Address - Country:US
Mailing Address - Phone:304-363-4533
Mailing Address - Fax:304-366-9809
Practice Address - Street 1:2690 WHITE HALL BLVD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8226
Practice Address - Country:US
Practice Address - Phone:304-363-4533
Practice Address - Fax:304-366-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV915OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149719000Medicaid
WV0149719000Medicaid
WV0765644Medicare ID - Type Unspecified
WV4018800001Medicare NSC