Provider Demographics
NPI:1942353891
Name:DR. KRESS EYECARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:DR. KRESS EYECARE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-842-4444
Mailing Address - Street 1:920 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1651
Mailing Address - Country:US
Mailing Address - Phone:304-842-4444
Mailing Address - Fax:304-842-4491
Practice Address - Street 1:920 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1651
Practice Address - Country:US
Practice Address - Phone:304-842-4444
Practice Address - Fax:304-842-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4000412000Medicaid
WV001994596OtherBCBS
WV1314480002OtherCIGNA GOVERNMENT SERVICES
WV1314480002OtherDMERC
WV1942353891OtherNPI
WVCG7036OtherRAILROAD
WV1314480002OtherDMERC
WV4000412000Medicaid