Provider Demographics
NPI:1922178474
Name:TEA VISION INC
Entity Type:Organization
Organization Name:TEA VISION INC
Other - Org Name:VALLEY VISION TEAYS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-757-8883
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:5 PUTNAM VILLIAGE
Mailing Address - City:TEAYS
Mailing Address - State:WV
Mailing Address - Zip Code:25569-0336
Mailing Address - Country:US
Mailing Address - Phone:304-757-8883
Mailing Address - Fax:304-757-8883
Practice Address - Street 1:5 PUTNAM VILLIAGE
Practice Address - Street 2:
Practice Address - City:TEAYS
Practice Address - State:WV
Practice Address - Zip Code:25569
Practice Address - Country:US
Practice Address - Phone:304-757-8883
Practice Address - Fax:304-757-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0151333001Medicaid
WV0151333001Medicaid