Provider Demographics
NPI:1205243177
Name:SAMMONS, GREGORY SHAWN (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SHAWN
Last Name:SAMMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9645
Mailing Address - Country:US
Mailing Address - Phone:304-757-2533
Mailing Address - Fax:304-757-2534
Practice Address - Street 1:3709 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9645
Practice Address - Country:US
Practice Address - Phone:304-757-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-12
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2010-IOD152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2010-IODOtherWEST VIRGINIA BOARD OF OPTOMETRY
WV2010-IOD1OtherWEST VIRGINIA BOARD OF OPTOMETRY