Provider Demographics
NPI:1356467278
Name:GLAUCOMA CONSULTANTS OF WHEELING
Entity type:Organization
Organization Name:GLAUCOMA CONSULTANTS OF WHEELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-234-1863
Mailing Address - Street 1:2101 JACOB ST STE 401
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3800
Mailing Address - Country:US
Mailing Address - Phone:304-234-1863
Mailing Address - Fax:304-234-1844
Practice Address - Street 1:2101 JACOB ST STE 401
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3800
Practice Address - Country:US
Practice Address - Phone:304-234-1863
Practice Address - Fax:304-234-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066784207W00000X
WV17583207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095128000Medicaid
WV0095128000Medicaid