Provider Demographics
NPI:1548594856
Name:NEW RIVER VISION CARE
Entity Type:Organization
Organization Name:NEW RIVER VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MS
Authorized Official - Phone:304-465-0269
Mailing Address - Street 1:1001 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2342
Mailing Address - Country:US
Mailing Address - Phone:304-465-0269
Mailing Address - Fax:304-465-1966
Practice Address - Street 1:1001 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2342
Practice Address - Country:US
Practice Address - Phone:304-465-0269
Practice Address - Fax:304-465-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1067-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6457580001Medicare NSC