Provider Demographics
NPI:1992269047
Name:REGIONAL EYE ASSOCIATES, INC
Entity type:Organization
Organization Name:REGIONAL EYE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAMPONIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-598-3301
Mailing Address - Street 1:1255 PINEVIEW DR.
Mailing Address - Street 2:WHITE BIRCH TOWER 1
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2738
Mailing Address - Country:US
Mailing Address - Phone:304-598-3301
Mailing Address - Fax:304-225-4289
Practice Address - Street 1:1405 CHANDELL ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2012
Practice Address - Country:US
Practice Address - Phone:304-598-3301
Practice Address - Fax:304-225-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty