Provider Demographics
NPI: | 1134519598 |
---|---|
Name: | DUNBAR EYE ASSOCIATES, PLLC |
Entity type: | Organization |
Organization Name: | DUNBAR EYE ASSOCIATES, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | WALTER |
Authorized Official - Last Name: | MOORE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 304-768-3332 |
Mailing Address - Street 1: | 1 STEWART PLZ |
Mailing Address - Street 2: | |
Mailing Address - City: | DUNBAR |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 25064-3041 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-768-3332 |
Mailing Address - Fax: | 304-768-5115 |
Practice Address - Street 1: | 1 STEWART PLZ |
Practice Address - Street 2: | |
Practice Address - City: | DUNBAR |
Practice Address - State: | WV |
Practice Address - Zip Code: | 25064-3041 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-768-3332 |
Practice Address - Fax: | 304-768-5115 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-01-23 |
Last Update Date: | 2022-07-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 1061-IOD | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |