Provider Demographics
NPI:1134543457
Name:MED SURG EYE CARE INC
Entity type:Organization
Organization Name:MED SURG EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAOUFIK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SADAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-252-4216
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:STANAFORD
Mailing Address - State:WV
Mailing Address - Zip Code:25927-0172
Mailing Address - Country:US
Mailing Address - Phone:304-252-4216
Mailing Address - Fax:304-253-6809
Practice Address - Street 1:22 MALLARD CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3615
Practice Address - Country:US
Practice Address - Phone:304-252-4216
Practice Address - Fax:304-253-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 156FX1800X, 332B00000X
WV20564207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1437241346OtherNPI
WV7169950001OtherDMERC, PTAN
WV1841345000Medicaid
WVSA4049742OtherMEDICARE PROVIDER NUMBER