Provider Demographics
NPI:1710984109
Name:MORRISON, DAVID BARRY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BARRY
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:838 SOMERSET BLVD
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5625
Practice Address - Country:US
Practice Address - Phone:304-725-4828
Practice Address - Fax:304-725-4829
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV782-OD152W00000X
VA618002978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150832000Medicaid
WV1169510001Medicare NSC
WV0150832000Medicaid
WV9208002Medicare PIN