Provider Demographics
NPI:1760519755
Name:HUNTINGTON EYE ASSOCIATES INC.
Entity Type:Organization
Organization Name:HUNTINGTON EYE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TULLY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ROISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-529-2800
Mailing Address - Street 1:1151 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3705
Mailing Address - Country:US
Mailing Address - Phone:304-529-2800
Mailing Address - Fax:304-529-2802
Practice Address - Street 1:1151 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3705
Practice Address - Country:US
Practice Address - Phone:304-529-2800
Practice Address - Fax:304-529-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001082Medicaid
KY65946212Medicaid
KY65946212Medicaid
WV9200812Medicare PIN