Provider Demographics
NPI:1962672576
Name:REGIONAL EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:REGIONAL EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-3301
Mailing Address - Street 1:1255 PINEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2713
Mailing Address - Country:US
Mailing Address - Phone:304-598-3301
Mailing Address - Fax:304-599-7346
Practice Address - Street 1:10 VALLEY VIEW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9543
Practice Address - Country:US
Practice Address - Phone:304-257-4555
Practice Address - Fax:304-599-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0007123000Medicaid
WV9274922Medicare PIN
WV0007123000Medicaid