Provider Demographics
NPI:1851504716
Name:POCKL-DORMAS PC
Entity Type:Organization
Organization Name:POCKL-DORMAS PC
Other - Org Name:EYECARE CENTER OF WHEELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:POCKL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-242-5544
Mailing Address - Street 1:2106 LUMBER AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5390
Mailing Address - Country:US
Mailing Address - Phone:304-242-5544
Mailing Address - Fax:304-242-2560
Practice Address - Street 1:2106 LUMBER AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5390
Practice Address - Country:US
Practice Address - Phone:304-242-5544
Practice Address - Fax:304-242-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV594-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0456970001Medicare NSC