Provider Demographics
NPI:1295987055
Name:WEIRTON EYE CLINIC, INC.
Entity type:Organization
Organization Name:WEIRTON EYE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:S
Authorized Official - Last Name:DECARIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-748-5230
Mailing Address - Street 1:3065 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4709
Mailing Address - Country:US
Mailing Address - Phone:304-748-5230
Mailing Address - Fax:304-748-2123
Practice Address - Street 1:3065 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4709
Practice Address - Country:US
Practice Address - Phone:304-748-5230
Practice Address - Fax:304-748-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVD-611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01-50654000Medicaid
DE9149241Medicare PIN
T32530Medicare UPIN