Provider Demographics
NPI:1578770889
Name:FERRELL EYE CLINIC, P.C
Entity Type:Organization
Organization Name:FERRELL EYE CLINIC, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-753-6001
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:PETERSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:24963-0566
Mailing Address - Country:US
Mailing Address - Phone:304-753-6001
Mailing Address - Fax:304-753-6002
Practice Address - Street 1:19 H MARKET ST
Practice Address - Street 2:
Practice Address - City:PETERSTOWN
Practice Address - State:WV
Practice Address - Zip Code:24963
Practice Address - Country:US
Practice Address - Phone:304-753-6001
Practice Address - Fax:304-753-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV927-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149753000Medicaid
WV0748264Medicare PIN
WV0149753000Medicaid