Provider Demographics
NPI:1659459592
Name:OPTOMETRIC PHYSICIANS OF PARKERSBURG INC
Entity Type:Organization
Organization Name:OPTOMETRIC PHYSICIANS OF PARKERSBURG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-485-7588
Mailing Address - Street 1:416 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5619
Mailing Address - Country:US
Mailing Address - Phone:304-485-7485
Mailing Address - Fax:304-485-5410
Practice Address - Street 1:416 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5619
Practice Address - Country:US
Practice Address - Phone:304-485-7485
Practice Address - Fax:304-485-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty